slee which are responsible for a patient losing consciousness is not yet clear. and most likely also depends on the anesthetic used. there are anesthetics that do not act on the messenger gaba but on the other neurotransmitters. to make it researchers are investigating these differences with a micro e.g. that measures signal transmission in the mini brains neurons. so far all anesthetic drugs have been found by trial and error doctors know that they work but not exactly how they work. however understanding the how is an important prerequisite for reducing side effects. we should really be looking at patients individual needs and tributes and choosing the substances they get accordingly we need a rational approach and not just a trial and error approach to see if it works and if it does that's good enough the

. trial and error right. in order to minimize and reduce errors perspective anesthesiologists at the height of bourke anesthesia and emergency medicine simulation center to sundogs. lab director and anesthesiologist christopher annoyed house explains the simulation one. time a 45 year old man was hit by a car in the city while walking he still awake as spontaneous breathing into circulation is stable most of the rest you'll see you in a moment. the instructors control the dog from the next room. talking i missed a good i'm the anything. could you open your mouth please oh. yes can you stretch

your neck. yes good friends a bit of a could you please do something for the pain my stomach hurts so much yes we'll give you something now mr glick they're going to begin the anesthesia. the 1st drug will make you a bit fuzzy we're going to take good care of you this is. it's interesting to see how quickly you forget that it's only a plastic doll with a bunch of telltale signs anyway once participants get used to the situation they don't just speak to the dog they show it real empathy and stroke its cheek and reassure it before the honest these your kicks in. which shows how quickly you can forget it's not real and yet snit the purpose of this exercise is to train team communication in stressful situations approximately 60 to 80 percent of problems during anaesthesia are due to human failure. should this kind of says it's was i wouldn't exactly call it failure because it's

a value judgment but the technology used in this area is so good that it's not the problem and it's these your machines don't just suddenly explode and devices don't suddenly fail which leads communication and teamwork where misunderstandings do occur that can lead to mistakes happening misfortune is off to it and be done this instead inference is a very good singer. the trainer simulate the worst case scenario cardiac arrest we don't have any circulation anymore so we need to press 3. because the pressure rising. with. my paws for a moment circulation is picking up. thanks very much let's stop here for no take a deep breath. did you think i was afraid. i think i could have called the

attending physician earlier before i started the anesthesia but i think overall we got through it while. the seminar is not a test participants actions are evaluated but no marks given also everything here is strictly confidential. each day over $40000.00 general anaesthetic sort ministered in germany lots of them at the clinic are w t h often. mark ober is preparing for a very special anesthesia an operation with xenon. xenon is a noble gas used in fluorescent tubes or car headlights and it can also be used in the operating theatre. seen on has been called the miracle anesthetic drug because it's proven to be well tolerated even by sensitive patients or people in very poor health. in contrast to other

anesthetics. it puts hardly any strain on circulation. the effect begins quickly and also disappears quickly so that patients regain alertness soon after surgery. but on this if you're not of the 0 i just wants to end the u.n. as the 0 that they can make a patient up very quickly this is the fastest drug we have and that is these are in terms of coronary flow dynamics the effect it has on blood pressure is very stable and patients blood pressure remains approximately what it was at the beginning which is much better for them and that was it to. cover and was researching how well elderly patients recovered after hip surgery he found that xenon anaesthesia leads to significantly less complications and mortality is also lower. seen on has been approved as an analyst. gas since 2005.

lab tests have shown that the noble gas has neuroprotective properties meaning it protects the brain from damage. but today it's only rarely used the reason for it is its cost. a one hour long anesthesia with xenon costs between 20300 euros other anesthetics are only about 50 euros. it would be great if we could generate more money. to be able to carry out large trials and to further research what we found so far. but there are many factors at play here. and at the moment it's uncertain whether xenon will even still be on the market in a few years time. because it's so expensive. and and corporations are deciding whether or not to continue this research the highlight of. our research project

can cost between 20 and 30000000 euros the money for this comes from industry. back in vienna. at the university hospital the operation we have been given permission to observe is underway. anesthesiologist who did she feel monitors the patients by the function blood pressure heartbeat and oxygen saturation. we want to know. in addition an e.g. monitor measures brain waves which helps determine the depth of anesthesia. to see india missed out in a heavy sea the stages a to f. the focused on the let's say basically means being awake from the b. and c.

can be read as lies and as these. as a kind of dozing. off asked stage is d. and e. show us that's like she has now a patient has a good depth of and this these and. there are no numbers on how often anesthesia is monitored with e.g. experts estimate the technique is part of routine procedure in less than half of all hospitals in germany. due to cheaper uses e.g. often but not exclusively is kind and so she didn't and various parameters can indicate that a patient is awakening or experiencing pain. in our line of work we also keep an eye on whether the patient is sweating or whether there's an increase in heart rate hike or an increase in blood pressure stick. and pupil which can also be a sign. as well as. the puts tween.

a study on intra operative alertness is currently underway in munich. patients need to have now is being prepared for knee surgery. this cap measures brain waves even more precisely than the standard 3 electrodes on the forehead. the researchers have developed a method for communicating with the patient in case she wakes up during surgery. a blood pressure cuff keeps the muscle relaxing medication from getting into her forearm. this ensures that if the patient is conscious while under anesthesia she can move her hand.

squeeze my hand. menace fish if there are fish in the sea squeeze my hand. if a stone floats in the words here squeeze my hand. and smash if you have pains he must raise my hand twice miss head. in the most recent study like this one almost 5 percent of patients did clench their hands. patients who take opioids regularly have a higher risk of regaining consciousness while still under anesthesia as do drug and alcohol addicts people who are often extremely scared of surgery. i have not made have not pressed my hand twice if everything's fine it's the inmates holding to that moment that we currently cannot rule out consciousness with 100 percent certainty using the methods of e.g. analysis we have now that's one problem the other problem is that the e.g.

only react when wakefulness has already occurred meaning that by the time the calculator to e.g. index value detect something the event already took place before. the study in munich is also examining subconscious memory can patients remember things in spite of anaesthesia. or cluck. cluck. into the industry factory to factory. only one word in each pair was mentioned during the operation the patient has to choose which feels more familiar. with him we are really still at the very beginning so we can't really predict the outcome yet but we have been surprised a few times on the one hand there are patients who clench their hand when asked to do so. and on the other hand there are also patients who even if they aren't consciously remembering. are able to recall lists that we played with

a high level of success. anesthesiologists at the university hospital have developed a new device for monitoring anesthesia the risk of waking up during an operation is particularly high when drugs are administered intravenously like propofol. one possible reason for this is that propofol concentration in the body cannot be measured yet. but in inhalation anesthetics the so-called blood gas partition coefficient describes this. the fact that the concentration of volatile anesthetics can be measured a measure of the concentration which i didn't have until now with propofol which is why the probability of over and under dosing is higher than with gas anesthetics. for. this new device is intended to remedy the situation the edm on

measures the concentration of propofol in the patient's body via his breath. says propofol is almost always used during general anesthesia induction but to maintain the artificial sleep in only around 20 percent of operations. he says that percentage is likely to rise significantly with the new edmund device. after the operation the researchers compare the values measured by the edmund with the propofol concentration in the blood. each patient process is the anesthetic differently. confusion anxiety hallucinations these are the symptoms of post operative delirium a. condition that more than a 3rd of patients over 60 experience. had

such a delirium in 2016 he suffered organ failure and was kept in an artificial coma for 4 weeks a long term general anaesthetic. the waking up basis lasted several days afterwards he was completely disoriented and had bit hallucinations. it was an intense phase when i couldn't tell if something was real. or if i was falling back into a dream i'd had before i really struggled to distinguish the 2. is still in touch with. the doctor who treated him back then. he would again and again have these phases where he was very agitated and that's

typical for a delirium. we call them function trajectories us where a patient moves between being very absent very subdued to being severely agitated and plagued by fear. but delirium will frequently damage a patient's brain permanently york naaman managed to recover fully. if you are someone who was pretty active before. and then you have to learn to walk again from wheelchair to walker to a crutch it can be frustrating but i think having our family really helped me because i wanted to get home again as quickly as possible that he intentionally that's all been through it's not yet clear what exactly triggers a delirium after a general anaesthetic. noice and

stress commotion studies show that conditions in intensive care units promote the development of delirium. told. this room and there will be a show clinic in berlin has been designed in a way intended to reduce deliriums and be able to treat them better. the most important strategy used in this intensive care unit of the future is providing patients with important so they don't feel lost for example like panels simulate the day night rhythm. secondly commotion a noise or avoided. nurses only enter the rooms when necessary otherwise they keep an eye on patients from a surveillance room. still has hope on all i think you can hear that it's much quieter in this room than in the other rooms in the mine in these normally intensive care rooms have noise levels of 80 decibels whereas here we're trying to

reduce it to 35. we're also trying to take all that he rises that scare patients out of their direct line of vision. which is why we position the breathing machine and syringe drivers behind to partition the splits and form. the 3rd part of the concept is to have alert active patients in the past long term sedation or even artificial comas were popular methods in intensive care units. today anesthesia has to be kept as brief as possible. just the every delirium we can avoid every damaged organ we can avoid reduces the risk of cognitive impairment 25 percent of patients have cognitive damage after intensive care with an impairment level similar to all timers. and that means they can't return to living alone at home just like they used to they can't return to

the job market or their professions and that's why i think we have to keep on top of. the new intensive care concept has reduced the number of delirium cases by a 3rd. but researchers at the shari take a want to begin their efforts earlier during surgery and. even in the deep with the anesthesia the more likely it is a delirium will occur so general anesthesia has to be deep enough for a patient to have no memories and no unpleasant sensations but not so deep that too much medication has to be administered to feel. that. the doctors at the shariat say and. when shows how this can be achieved using the example of a prostate removal. they combine general anesthesia with regional anesthesia. pain killers are injected directly into the abdomen to switch off any feelings of pain there.

when general anesthesia is accompanied by regional anesthesia a smaller dose of anesthetic suffices. i mean it's here and here we have a general anesthesia with a very low concentration of inhalation and is there 6. we giving the patient so little the machines are sounding the alarm to say you are using too little medication your patient will wake up because machines and he is too us watching and reading the igi line but it shows us that he's under far enough from the actually of. death the dentist t.c.m. dosage of medication duration of anesthesia details on all 3 factors during the operation are collected and say. these details are subsequently combined with data on the patient's health and postoperative recovery for the bio cock study at the

shari today. the aim of this study is to give researchers a measure of whether their efforts can successfully prevent a delirium after the operation anesthesiologist on a camilla helps the patient get his bearings at the earliest possible time. it's 20 to 6 pm the operation is over you're in the recovery room you can now take your time to wake and your wife already know. this is a checklist is used to ascertain whether a delirium is happening. but is everything ok. there are. some you know that some delirium patients are hyperactive or aggressive others apathetic and absent at the latter it's especially hard to detect a delirium. you've said you see and hear me well. and we can also talk to each

other well. that's. the study on delirium risk factors involved 1200 patients between 65 and 80 years old. their physical and mental conditions before and after the operation are tested and compared. if you want to oppose a test at any point just let me know and i'll stop. the studies participants will be accompanied for 3 years. early results already indicate several risk factors. these include cardiovascular diseases metabolic disorders such as diabetes and infections in the body. researchers concluded that especially higher risk patients should be closely monitored for signs of delirium. they also suggest caregivers and relatives should take particular care of them. back in vienna.

utero surgery is over and everything went fine. anaesthesiologist you the chief earth has turned off the sleeping drug during the final phase of the operation. all that's left now is to wait. to see still far far away. the waking up base is critical. both the sleep inducing drugs and the muscle relaxants should stop working at the same time. in 5 man hits in the high if the effect of a muscle relaxant hasn't worn off the patient could find themselves in a situation where they want to breathe but cons because their muscle function isn't fully restored yet most kids who are on the space today it's to me to him he's. that's what. put 10 market morning. good morning and deep

breaths in the end out take a deep breath and one open your mouth why it's guns take your time yeah come on yes we can take it out yeah come on out and open your mouth half a perfect good morning. oh god it hurts. the patient is in pain this shouldn't be the case. t. file deep breaths in and out of the big brain. this. you didn't see for and checks some more painkillers. still. i listen i'm still not cool so good but only know the anesthesia went well in the city however in the end the patient needed

a higher dose of painkillers than we initially thought. this has to do with pain pills section varying between people so it's hard to previous says it. bottoms. every person's perception of pain is different researchers make use of this in their search for alternatives to general anesthesia. for example in the end to this thing there's fresh clean air. coming in through the window. hypnosis instead of anesthesia and sounds a bit like a joke. but neurosurgeon. is building on a long tradition. during the early days of surgery practically every operation was performed with the use of hypnosis but with the development of

modern drugs this is been completely forgotten. at the university hospital of vienna hypnosis is used for brain surgery. this patient has parkinson's disease because deep brain stimulation is supposed to reduce the strong tremor. gnosis also slows breathing and he celebrates the heartbeat. but in contrast to anesthesia here the patient is fully conscious. even when a hole is drilled in his skull. the hypnotist incorporates the sounds into the hypnosis you're good. but the construction workers won't stop the even start grilling with the pneumatic hammer or maybe you can open your mouth and it's not so bad to exactly. smell something convicting pain perception is used in hypnosis as in the patient feels the pain but this can be incorporated into other

experiences and rebuilt so that it's positive and not so unpleasant. and. this is the patient only receives pain killers but no sleep inducing drugs. in order to check whether the electrodes for deep brain stimulation are correctly positioned the patient is taken out of hypnosis this is. the count of 3 open your eyes wide and take a good breath ok they're all here and there. if you know what organization is as much in your ologists it's important to be able to test patients during the operation to see the effect on the trauma and for that the patient needs to be awake and alert or general anesthesia sometimes doesn't clear up straight away or patients are tired so they can do the tasks promptly that's different with hypnosis patients are awake and can participate well which helps improve the surgery outcome as though there were none of those and. no says has many advantages

patients are less scared their blood circulation is more stable bleeding happens less often less pain medication gets used and patients who are hypnotised stay in hospitals for less time than those who received general anesthesia. medicine has made huge leaps forward in only one in 136000 operations has a patient died from the effects of anesthesia. going under anesthesia 30 years ago was very different to our it is today in terms of tolerance effectiveness maintenance side effects. but there's still room for improvement using e.g. to monitor anesthesia at depth is not yet standard everywhere. i still don't understand why anesthesiologist measure everything blood pressure heart rate saturation but the brain where things are happening isn't monitored. basic research

will continue developing and perhaps someday lift the mystery of anesthesia. we need personalized on a c.c.i. that's the point but we don't have that. doesn't the modern day. artists search for trees or. mark. things up. easy.

20. 30 minutes w. . or. the big. it's an ongoing quest for a bit of. the arab spring began in 2011. people stood up against corrupt travelers and dictatorships. all these moments. have left deep box in my memory. the be they had hoped for more security more freedom more dignity. have their hopes been

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villagers find the bodies of hundreds of. strewn along the banks of the river ganges. and time.