[Anesthesia in a patient after endoscopic lung volume reduction. First anesthesiological experiences with implanted endobronchial valves]. / Narkose bei einem Patienten mit Zustand nach endoskopischer Lungenvolumenreduktion. Erste anästhesiologische Erfahrungen mit implantierten "Lungenventilen"

Chronic obstructive pulmonary disease (COPD) is a disease with a high incidence and extensive comorbidities that make COPD a key challenge for anesthesiologists. A new treatment strategy, such as endoscopic lung volume reduction (ELVR) with implantation of endobronchial valves is a rapidly developing area which is still unknown to many anesthesiologists. This article therefore describes first experiences in a patient with five endobronchial valves in the right upper lobe who needed urgent surgery due to lumbar disc herniation with neurological impairment. After preoperative evaluation of the patient's condition, the use of bronchodilating volatile anesthetics and adjusting the ventilatory settings with long expiration times and low peak pressure in a pressure controlled mode seems favorable in these patients. Intraoperatively, the patient should be assessed with modern physiological monitoring tools to titrate the administration of anesthetic agents, opioids and myorelaxant drugs. In conclusion the care of patients with implanted endobronchial valves after ELVR does not differ from COPD patients without ELVR. A close cooperation between surgeons, anesthesiologists and internists is mandatory in the care of these patients.

[Implementation of the German guideline for the prevention, diagnosis, treatment and follow-up of non-small cell lung cancer at the Diakoniekrankenhaus Halle/Saale]. / Umsetzung der aktuellen S3-Leitlinie zur Prävention, Diagnostik, Therapie und Nachsorge des nicht-kleinzelligen Lungenkarzinoms am Diakoniekrankenhaus Halle/Saale.

BACKGROUND: More than three years since the release of the german guideline for the prevention, diagnosis, treatment and follow-up of lung cancer the database in terms of the implementation of guideline recommendations is deficient. The aim of this article is to analyze the implementation of the recommended algorithms for first-line therapy of non-small cell lung cancer. PATIENTS AND METHODS: On the basis of the patients records we determined all cases of newly diagnosed non-small cell lung cancer which received a first-line therapy at the Diakoniekrankenhaus Halle/Saale between January 2010 and December 2011. The demographic data, tumor stage, time of diagnosis and performed first-line therapy were documented. Each case was assigned to the groups "guideline-adherent treatment" or "deviation from guideline recommendation" in dependency of its tumor stage. For this assignment the corresponding algorithms from guideline chapter "Therapy of non-small lung cancer" were used. RESULTS: A total of 126 from 148 cases (85%) received guideline-adherent treatment. Deviation from guideline recommendation was found in 22 cases (15%). The categories "poor performance status", "technical factors", "patient decision" and "others" were determined as the main reasons for non guideline-adherent treatment. CONCLUSIONS: Based on the analyzed population this study determined a high grade of guideline adherence at the period of investigation. Otherwise it shows that guideline recommendations cannot include each individual factor of the complex lung cancer disease. It could be found a wide range of reasons for deviation from the guideline recommendations.