InterCarb: A Community Effort to Improve Interlaboratory Standardization of the Carbonate Clumped Isotope Thermometer Using Carbonate Standards.

Increased use and improved methodology of carbonate clumped isotope thermometry has greatly enhanced our ability to interrogate a suite of Earth-system processes. However, interlaboratory discrepancies in quantifying carbonate clumped isotope (Δ47) measurements persist, and their specific sources remain unclear. To address interlaboratory differences, we first provide consensus values from the clumped isotope community for four carbonate standards relative to heated and equilibrated gases with 1,819 individual analyses from 10 laboratories. Then we analyzed the four carbonate standards along with three additional standards, spanning a broad range of δ47 and Δ47 values, for a total of 5,329 analyses on 25 individual mass spectrometers from 22 different laboratories. Treating three of the materials as known standards and the other four as unknowns, we find that the use of carbonate reference materials is a robust method for standardization that yields interlaboratory discrepancies entirely consistent with intralaboratory analytical uncertainties. Carbonate reference materials, along with measurement and data processing practices described herein, provide the carbonate clumped isotope community with a robust approach to achieve interlaboratory agreement as we continue to use and improve this powerful geochemical tool. We propose that carbonate clumped isotope data normalized to the carbonate reference materials described in this publication should be reported as Δ47 (I-CDES) values for Intercarb-Carbon Dioxide Equilibrium Scale.

Low-Dose Eptifibatide for Tandem Occlusion in Stroke: Safety and Carotid Artery Patency.

BACKGROUND AND PURPOSE: Maintaining carotid patency and avoiding symptomatic intracranial hemorrhage are competing concerns in tandem occlusions. This study provides data regarding the safety and efficacy of eptifibatide in stroke from tandem occlusion of the extracranial carotid artery and the intracranial carotid or middle cerebral artery. MATERIALS AND METHODS: This is a retrospective analysis of 58 consecutive patients who received low-dose eptifibatide (135-mcg/kg bolus, 1-mcg/kg/min infusion) during treatment of tandem occlusions. Brain imaging and carotid sonography were performed at 24-36 hours. mRS was documented at 90 days, and carotid sonography, at 30-60 days. RESULTS: The median age and NIHSS score were 64 years and 15, respectively. Twenty-five patients (43%) received tPA. ASPECTSs were 8-10 in 47 (81%) and 5-7 in 11 (19%) patients. Thirty-eight patients had angioplasty/stent placement acutely; 20 had angioplasty alone. Symptomatic intracranial hemorrhage occurred in 1 patient (2%). TICI 2b or higher was achieved in 56 patients (96%). Fifty-seven of 58 patients had clinical follow-up at 90 days (1 lost to follow up). The 90-day mRS was 0-2 in 42 patients (72%). There were 4/58 (7%) re-occlusions within 24-36 hours, all originally treated with stent placement. Forty-nine of 53 surviving patients had carotid sonography at 30-60 days, with 3 delayed re-occlusions, 2 with stents and 1 with angioplasty alone. The overall carotid patency at 30-60 days was 42/49 (86%). Carotid re-occlusion was not associated with clinical decline. CONCLUSIONS: Low-dose eptifibatide seemed to be safe in tandem occlusions (symptomatic intracranial hemorrhage, 2%), although asymptomatic cervical carotid artery re-occlusions still occurred in 14% of patients.

[Patient with a Fontan circulation undergoing caesarean section: Anesthesiological management]. / Sectio caesarea bei einer Patientin mit Fontan-Zirkulation : Anästhesiologisches Management.

Adults suffering from congenital heart diseases (CHD) represent a challenge to anesthesiologists because of the diverse pathologies, complex pathophysiology and special treatment strategies. Due to improved therapeutic options for CHD, patient quality of life and life expectancy is increasing, leaving them as a growing population including pregnant patients with CHD. This article presents the main principles of the pathophysiology and anesthesiological management of pregnant patients living with a Fontan circulation based on a case report, which was complicated by an aortic coarctation and atonic uterine hemorrhage.

Effect-site concentration of remifentanil during patient-controlled analgesia in labour.

BACKGROUND: Intravenous remifentanil has been described for patient-controlled analgesia in labour. Recently, the application of target-controlled infusion pumps with Minto's pharmacokinetic/pharmacodynamic model has been reported. Hypothetical effect-site remifentanil concentration during patient-controlled analgesia for labour has yet to be examined. The aim of this concept study was to explore characteristics of this parameter. METHODS: We performed a historical cohort study based on our previous randomised cross-over clinical trial and analysed hypothetical effect-site remifentanil concentration. Values at spontaneous vaginal delivery and Apgar scores were tested for correlation. The association between pain score and the corresponding effect-site remifentanil concentration before and after bolus administration, and their relative difference, was examined with a linear mixed-effects model, adjusted for other variables. RESULTS: A series of 23 parturients with uncomplicated singleton pregnancies were included. On average, effect-site remifentanil concentration was highest during the third quarter throughout our recordings (5.5ng/mL; maximum 15.8ng/mL). The mean (median) {IQR} [range] at spontaneous vaginal delivery (n=14) was 2.52 (1.32) {0.95-4.28} [0.65-6.88] ng/mL, all Apgar scores were >7, and no correlation was confirmed. A negative association between effect-site remifentanil concentration before bolus administration and pain score (scale 0-100) was observed (-3.9, 95% CI -5.16 to -2.61, P <0.01). CONCLUSIONS: The residual value of hypothetical effect-site remifentanil concentration before uterine contraction, at the beginning of bolus administration, predicted lower pain scores. Monitoring effect-site remifentanil concentration may be potentially useful when remifentanil is administered for labour analgesia. However, our results need to be confirmed with a pharmacokinetic model optimized for pregnant patients.

Structured illumination fluorescence microscopy with distorted excitations using a filtered blind-SIM algorithm.

Structured illumination microscopy (SIM) is a powerful technique for obtaining super-resolved fluorescence maps of samples, but it is very sensitive to aberrations or misalignments affecting the excitation patterns. Here, we present a reconstruction algorithm that is able to process SIM data even if the illuminations are strongly distorted. The approach is an extension of the recent blind-SIM technique, which reconstructs simultaneously the sample and the excitation patterns without a priori information on the latter. Our algorithm was checked on synthetic and experimental data using distorted and nondistorted illuminations. The reconstructions were similar to that obtained by up-to-date SIM methods when the illuminations were periodic and remained artifact-free when the illuminations were strongly distorted.

Modified patient-controlled remifentanil bolus delivery regimen for labour pain*.

To improve the analgesic efficiency and to simplify the administration of remifentanil for systemic analgesia in labour, we contrived a modified delivery regimen with a specific infusion profile and variable dosing and conducted a single-blind randomised crossover study to compare it with the previous 'classical' regimen. Parturients received both regimens in interchangeable sets, each with five contractions. We compared pain and satisfaction scores, maternal and fetal vital parameters, side-effects and other events. Twenty-three parturients completed the study. No differences in observed parameters were noticed except for slightly lower blood pressure with the modified regimen. Pain estimates were lower in women starting with the modified regimen (p = 0.005), and there were fewer requests for analgesia within the lockout period (31 vs 69, p = 0.041) and bolus adjustments (0 vs 25, p < 0.001) with the modified regimen.

Repeated transarterial chemoembolisation using different chemotherapeutic drug combinations followed by MR-guided laser-induced thermotherapy in patients with liver metastases of colorectal carcinoma.

BACKGROUND: To evaluate a treatment protocol with repeated transarterial-chemoembolisation (TACE) downsizing before MR-guided laser-induced interstitial thermotherapy (LITT) using different chemotherapeutic combinations in patients with unresectable colorectal cancer (CRC) liver metastases. METHODS: Two hundred and twenty-four patients were included in the current study. Transarterial-chemoembolisation (mean 3.4 sessions per patient) was performed as a downsizing treatment to meet the LITT requirements (number5, diameter <5 cm). The intra-arterial protocol consisted of either Irinotecan and Mitomycin (n=77), Gemcitabine and Mitomycin (n=49) or Mitomycin alone (n=98) in addition to Lipiodol and Embocept in all patients. Post TACE, all patients underwent LITT (mean 2.2 sessions per patient). RESULTS: Overall, TACE resulted in a mean reduction in diameter of the target lesions of 21.4%. The median time to progression was 8 months, calculated from the start of therapy and the median local tumour control rate was 7.5 months, calculated as of therapy completion. Median survival of patients calculated from the beginning of TACE was 23 months (range 4-110 months), in patients treated with Irinotecan and Mitomycin the median was 22.5 months, Gemcitabine and Mitomycin 23 months and Mitomycin only 24 months with a statistically significant difference between the groups (P<0.01). CONCLUSION: Repeated TACE offers adequate downsizing of CRC liver metastases to allow further treatment with LITT. The combined treatment illustrates substantial survival rates and high local tumour control with statistically significant differences between the three protocols used. Further randomised trials addressing the current study results are required.

Synchronized communication between people with dementia and their volunteer caregivers. A video-based explorative study on temporal aspects of interaction and the transfer to education.

Processes of demographic change are leading to decreasing human resources in professional as well as lay care; this decrease necessitates new concepts of care, especially for the growing number of people with dementia (p.w.d.). Since the amendment to the German Care Insurance Law (2002), family carers have been entitled to regular weekly relief, provided by volunteers who have been given a thirty-hour-training. As difficulties in information processing in p.w.d. form an important part of the symptoms in dementia sufferers--with a high impact on communication as well as competent functioning in activities associated with daily life, we wanted to establish how much awareness and sensitivity voluntary attendants show in "tuning in" to the p.w.d. and her/his individual capacity to interact. In an exploratory study the authors analyzed videotaped interactions between volunteer caregivers and dementia-sufferers which were recorded in everyday situations during the process of ongoing care. Using methods of Video Interaction Analysis and Grounded Theory, we developed categories which describe how in tune the helpers are with the timing skills--or lack of them--of p.w.d.. We think that understanding the different ways in which p.w.d. structure their time can improve their communication and interaction. The categories --"speed and adjustment of speed", "mutuality" and "time control"--seemed crucial in understanding the subsequent course of the interactions. In a second step, these categories have recently been used by students and staff of the Lausitz University of Applied Sciences to provide training that sensitizes volunteer attendants to the topic and to learn about volunteers; judgement on the importance of continuing education in this field.

Examining the influence of maternal bradycardia on neonatal outcome using automated data collection.

BACKGROUND: Due to the increasing number of caesarean sections, we investigated the influence of maternal bradycardia during general and regional anaesthesia on seven standard paediatric outcome parameters using our online recorded data. METHODS: Data from 1154 women undergoing caesarean section were investigated prospectively. Bradycardia was defined as a heart rate below 60 beats/min. The matched-pairs method was used to evaluate the impact of bradycardia on Apgar scores at 1, 5, and 10 min, umbilical artery pH and base excess, admission to paediatric intensive care unit, and seven-day mortality. Matched references were automatically selected among all patients from the data pool according to anaesthetic technique, sensory block height, urgency, maternal age and body mass index. Stepwise regression models were developed to predict the impact of intra-operative bradycardia on outcome variables with differences between matched pairs assessed using univariate analysis. RESULTS: Bradycardia was found in 146 women (12.7%) for whom a control could be matched in 131 cases (89.7%). Mean 5-minute Apgar score was 9.2+/-1.1 for study patients and 9.3+/-1.1 for controls. pH and base excess were not significantly different between groups. In cases of urgent surgery, neonates had an increased risk of 1.8 (95% CI 1.36-2.44, P<0.01) for an Apgar score

User acceptance of an anaesthesia information management system.

BACKGROUND AND OBJECTIVE: This paper describes the user acceptance of an anaesthesia information management system at the University Hospital in Giessen, Germany, after 5 yr of routine use. METHODS: A questionnaire with 75 items was distributed to all anaesthesiologists and anaesthetic nurses of the Department of Anaesthesiology. The questions were answered anonymously on a five-point Likert scale. RESULTS: The return rate was 60% (44 physicians and 24 nurses). The results indicated that the system generally met user expectations. The respondents thought that electronic record keeping improved the quality of their work, and they did not want to switch back to paper records. Problems arose with hardware placement and software features, e.g. coding tools for diagnoses and type of surgery. The perceived quality of training strongly influenced user acceptance. CONCLUSIONS: Despite the deficits revealed by the survey, the respondents did not want to switch back to manual record keeping. A structured user survey is a useful tool for the development, adaptation and implementation of an anaesthesia information management system. A training strategy that takes the needs of the users into account is recommended.

Outcome prediction in a surgical ICU using automatically calculated SAPS II scores.

The objective of this study was to establish a complete computerized calculation of the Simplified Acute Physiology Score (SAPS) II within 24 hours after admission to a surgical intensive care unit (ICU) based only on routine data recorded with a patient data management system (PDMS) without any additional manual data entry. Score calculation programs were developed using SQL scripts (Structured Query Language) to retrospectively compute the SAPS II scores of 524 patients who stayed in ICU for at least 24 hours between April 1, 1999 and March 31, 2000 out of the PDMS database. The main outcome measure was survival status at ICU discharge. Score evaluation was modified in registering missing data as being not pathological and using surrogates of the Glasgow Coma Scale (GCS). Computerized score calculation was possible for all investigated patients. The 459 (87.6%) survivors had a median SAPS II of 28 (interquartile range (IQR) 13) whereas the 65 (12.4%) decreased patients had a median score of 43 (IQR 16; P < 0.001). Of the physiological variables for SAPS II score calculation, bilirubin was missing in 84%, followed by PaO2/FiO2 ratio (34%), and neurological status (34%). Using neurological diagnoses and examinations as surrogates for the GCS, a pathological finding was seen in only 8.8% of all results. The discriminative power of the computerized SAPS II checked with a receiver operating characteristic (ROC) curve was 0.81 (95% confidence interval (CI): 0.74-0.87). The Hosmer-Lemeshow goodness-of-fit statistics showed good calibration (H = 5.55, P = 0.59, 7 degrees of freedom; C = 5.55, P = 0.68, 8 degrees of freedom). The technique used in this study for complete automatic data sampling of the SAPS II score seems to be suitable for predicting mortality rate during stay in a surgical ICU. The advantage of the described method is that no additional manual data recording is required for score calculation.

Potential benefits of Anaesthesia Information Management Systems for multicentre data evaluation: risk calculation of inotropic support in patients undergoing cardiac surgery.

OBJECTIVE: The aim of this study was to test the hypothesis whether it is easily possible to transfer and apply the methods of data extraction and analysis of a performed study to a data pool of a different medical centre using the same type of Anaesthesia Information Management System (AIMS). For this purpose the objective of a study in cardiac anaesthesia, investigated at the University Hospital Giessen, was applied to the data pool of the Heart Centre Siegburg. RESEARCH DESIGN AND METHODS: The Giessen study evaluated factors related to the use of positive inotropic drugs (PIDs) in adults undergoing elective cardiac surgery with cardiopulmonary bypass (CPB). The same objective and methods were applied to data of 1672 patients of the Heart Centre Siegburg. In both centres anaesthetic procedures were recorded with the AIMS NarkoData. Existing database queries were adapted according to the Siegburg database configuration for detection of patients having received PIDs during or after weaning from CPB. RESULTS: It was revealed that data from the Siegburg database using the same data model and configuration, were identical to the Giessen database except for a few items only. Thus database queries of the Giessen study could be applied to the new data pool requiring no considerable additional input. CONCLUSIONS: We could demonstrate that multicentre data analysis in anaesthesia using AIM systems can be carried out successfully. Once the methods of data extraction and analysis are established they can be transferred to data pools of different centres without requiring additional time, personnel and material resources.

[Risk predictors, scoring systems and prognostic models in anesthesia and intensive care. Part I: anesthesia]. / Risikoindizes, Scoring-Systeme und prognostische Modelle in der Anästhesie und Intensivmedizin. Teil I: Anästhesie.

Risk predictors and scoring systems are commonly used in medicine to provide a reliable and objective estimation of disease prognoses, probability of adverse events and outcome. Furthermore, they were designed to classify severity of illness or the course of diagnostic and therapeutic interventions and to perform a risk stratification for scientific studies in a standardized way. In quality management and cost control, scoring systems and predictors are used for risk adjustment and evaluation of care performance. The aim of this review article was to describe common risk indices and scoring systems in anesthesia (part I) and intensive care (part II), and to point out their possible benefits and limitations. Different scoring systems and classifications are available to stratify perioperative risk and adverse events in anesthesia. Especially in cardiac surgery, an increasing interest in risk-adjusted outcome studies led to the modeling and validation of different prognostic systems for postoperative morbidity, mortality and length of stay. Furthermore, there are scoring-systems for special events, such as difficult laryngoscopy or postoperative nausea and vomiting (PONV). Risk check lists and risk indices are superior to the ASA classification of physical status in providing more exact results and the possibility of statistic risk calculation. Nevertheless, they are not frequently used in clinical routine. Because of its simplicity and easy handling the ASA classification has worldwide popularity and recent studies demonstrated at least equal prognostic performance.

The use of an anesthesia information management system for prediction of antiemetic rescue treatment at the postanesthesia care unit.

UNLABELLED: We used an anesthesia information management system (AIMS) to devise a score for predicting antiemetic rescue treatment as an indicator for postoperative nausea and vomiting (PONV) in the postanesthesia care unit (PACU). Furthermore, we wanted to investigate whether data collected with an AIMS are suitable for comparable clinical investigations. Over a 3-yr period (January 1, 1997, to December 31, 1999), data sets of 27,626 patients who were admitted postoperatively to the PACU were recorded online by using the automated anesthesia record keeping system NarkoData(R) (IMESO GmbH, Hüttenberg, Germany). Ten patient-related, 5 operative, 15 anesthesia-related, and 4 postoperative variables were studied by using forward stepwise logistic regression. Not only can the probability of having PONV in the PACU be estimated from the 3 previously described patient-related (female gender, odds ratio [OR] = 2.45; smoker, OR = 0.53; and age, OR = 0.995) and one operative variables (duration of surgery, OR = 1.005), but 3 anesthesia-related variables (intraoperative use of opioids, OR = 4.18; use of N(2)O, OR = 2.24; and IV anesthesia with propofol, OR = 0.40) are predictive. In implementing an equation for risk calculation into the AIMS, the individual risk of PONV can be calculated automatically. IMPLICATIONS: The aim of this study was to investigate predictors for postoperative nausea and vomiting by using online anesthesia records. With the help of computerized data evaluation, 7 of 34 variables could be detected as risk factors. By implementing an automatic score into the record keeping system, an individual risk calculation could be made possible.

Using an anesthesia information management system to prove a deficit in voluntary reporting of adverse events in a quality assurance program.

OBJECTIVE: A deficit is suspected in the manual documentation of adverse events in quality assurance programs in anesthesiology. In order to verify and quantify this, we retrospectively compared the incidence of manually recorded perioperative adverse events with automatically detected events. METHODS: In 1998, data of all anesthetic procedures, including the data set for quality assurance of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI), was recorded online with the Anesthesia Information Management System (AIMS) NarkoData4 (Imeso GmbH). SQL (Structured Query Language) queries based on medical data were defined for the automatic detection of common adverse events. The definition of the SQL statements had to be in accordance with the definition of the DGAI for perioperative adverse events: A potentially harmful change of parameters led to therapeutic interventions by an anesthesiologist. RESULTS: During 16,019 surgical procedures, anesthesiologists recorded 911 (5.7%) adverse events manually, whereas 2966 (18.7%) events from the same database were detected automatically. With the exception of hypoxemia, the incidence of automatically detected events was considerably higher than that of manually recorded events. Fourteen and a half percent (435) of all automatically detected events were recorded manually. CONCLUSION: Using automatic detection, we were able to prove a considerable deficit in the documentation of adverse events according to the guidelines of the German quality assurance program in anesthesiology. Based on the data from manual recording, the results of the quality assurance of our department match those of other comparable German departments. Thus, we are of the opinion that manual incident reporting seriously underestimates the true occurrence rate of incidents. This brings into question the validity of quality assurance comparisons based on manually recorded data.

Involvement of K(+) channels in the relaxant effects of YC-1 in vascular smooth muscle.

This study addresses the question whether K(+) channels are involved in the vasorelaxant effects of 3-(5'-hydroxymethyl-2'-furyl)-1-benzyl-indazole (YC-1 ). In rat aorta, guinea pig aorta, and guinea pig a. carotis, YC-1 inhibited contractions induced by phenylephrine (3 microM) more potently than those induced by K(+)(48 mM). In rat aorta, tetraethylammonium (10 mM), charybdotoxin (0.2 microM), and iberiotoxin (0.1 microM), but not glibenclamide (10 microM), attenuated the relaxant effects of YC-1. In guinea pig a. carotis, YC-1 (30 microM) induced a hyperpolarisation which was antagonised by 1H-[1,2,4]oxadiazolo[4, 3-a]quinoxalin-1-one (ODQ; 50 microM). In rat aorta, YC-1 (30 microM) increased the rate constant of 86Rb-efflux. The effect of YC-1 was potentiated by zaprinast (10 microM), but inhibited by ODQ (50 microM) or charybdotoxin (0.2 microM). In smooth muscle cells from rat aorta, YC-1 (10 microM) increased BK(Ca) channel activity. It is suggested that YC-1-induced vasorelaxation is partially mediated by the activation of K(+) channels.

[Quality documentation with an Anaesthesia Information Management System (AIMS)]. / Qualitätsdokumentation mit einem Anästhesie-Informations-Management-System (AIMS).

OBJECTIVE: In 1994 the Department of Anaesthesiology and Intensive Care Medicine of the Justus Liebig University of Giessen decided to implement an Anaesthesia Information Management System (AIMS) to replace the previous hand-written documentation on paper. From 1997 until the end of 1998 the data sets of 41,393 anaesthesia procedures were recorded with the help of computers and imported into a data bank. Individual aspects and results of this data pool are presented under the aspect of how the system in its present form is able to guarantee documentation of quality according to the requirements of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI). METHODS: Since 1997 information on all anaesthesia procedures has been documented "online" with the anaesthesia documentation software NarkoData 4 (ProLogic GmbH, Erkrath). The data sets have been stored in a relational data bank (Oracle Corporation) and statistically processed with the help of the SQL-based program Voyant (Brossco Systems, Espoo, Finland). As an example of two adverse perioperative events (AVB) we compared incidences of "hypotension" and "nausea/vomiting", recorded by staff members into the AIMS, with the incidence of comparable events that were recorded with the help of online data during anaesthesia procedures, such as blood pressure and drug application. Since 1998 data recording has been revised constantly in department meetings; advanced training has been given. The results have been analysed critically. RESULTS: In 1997 the incidence of adverse perioperative events entered manually into the system was 3.6% (grade III and higher 0.9%) and increased during 1998 to 22.2% (grade III and higher 1.9%). The frequency of anaesthesia procedures with manually documented AVBs was significantly below the incidence (determined with the help of online data) of comparable events: "hypotension" (1.8% vs. 8.5%) and "nausea/vomiting" (4.9% vs. 8.3%). CONCLUSION: The current documentation of AVBs in almost any hospital is incomplete. In contrast to the hand-written procedure, the AIMS provides recorded data for evaluation and guarantees more detailed and complete quality documentation. In addition, the effort needed for documentation is reduced. Whether these data sets really describe and measure quality or not has to be evaluated. In addition it has to be considered whether different requirements (such as automatic AVB recognition for an AIMS) are advantageous for quality documentation regarding the data raster and the AVB recognition, with respect to different documentation procedures.

[Statistics and evaluation of a graphic SQL user interface in an anesthesia information management system (AIMS)]. / Statistiken und Auswertungen mit einer grafischen SQL-Oberfläche im Rahmen eines Anästhesie-Informations-Management-Systems (AIMS).

PURPOSE: Since 1997, the Anaesthesia Information Management Systems (AIMS) in our department has produced extensive data material (DGAI core data, vital sign parameters, respiratory parameters, material consumed, etc.) which is stored in a relational data bank. The processing of this data by means of SQL queries was restricted to a few persons with special knowledge only. It was the objective of the project to create an evaluation tool which enables each member of the department to enter queries concerning topics such as efficiency records, quality management, training and research at any time. The tool was also intended to present results in an adequate form. METHODS: Since 1997, the data of the performed anaesthesia procedures have been recorded using the online anaesthesia documentation software NarkoData Version 4 (ProLogic GmbH, Erkrath) within the AIMS. The recorded data sets have been imported into a relational Oracle data bank (Oracle Corporation). The commercial programme Voyant (Brossco Systems, Espoo, Finland) enables for the user to formulate SQL-requests (Structured Query Language) with the help of a graphic user interface and to present the results in a variety of graphics and tables. Repetition of the evaluation using the current data is possible at any time. RESULTS: During 1997 and the first quarter of 1998, the data of 26,030 anaesthesia procedures have been registered and stored in the anaesthesiological data base. 235 queries could be formulated with the SQL-capable graphic tool Voyant. They are available to each member of the department by the application of NarkoStatistik (IMS GmbH, Giessen) within the AIMS, together with the corresponding documentation (HTML pages). The query catalogue covers the main topics of efficiency, quality management, organisation, diagnoses and surgery, pre-, intra- and postoperative data and day-care unit. Even without much previous experience with the system it is possible to carry out evaluations with the current data at selected AIMS terminals. Queries concerning other subjects can be created and can be integrated into the existing query catalogue. CONCLUSION: With the described application we are able to establish an evaluation tool which fulfils our expectations regarding user friendliness and the subjects the queries can cover. Today it has a central position within the AIMS. In addition to the anaesthesia documentation software and the data bank structure, the efficiency of an AIMS is mainly influenced by the corresponding evaluation tool.