Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2004
Review[Dilutional coagulopathy, an underestimated problem?].
When no fresh frozen plasma is available, acute major blood loss is compensated above all with crystalloids, colloids and erythrocyte concentrates, meaning that all plasma clotting factors are diluted. Consumption coagulopathy is almost always accompanied by dilutional coagulopathy. Formulas for calculating critical blood loss and standard coagulation tests are often not helpful in the case of massive transfusion. ⋯ If this is not available in sufficient quantity or within a reasonable time, coagulation factor concentrates must be used. Neither fresh frozen plasma therapy nor treatment with coagulation factor concentrates has been the subject of detailed clinical study. Further studies are needed to work out guidelines for coagulation management in the case of massive blood loss.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2004
Review[Monitoring of Perioperative Dilutional Coagulopathy Using the ROTEM Analyzer: Basic Principles and Clinical Examples].
Recent changes in quality of transfusion supply, transfusion triggers as well as fluid therapy promote the development of dilutional coagulopathy. Nevertheless, up to now guidelines generally assume presence of hypocoagulability when more than one individual circulating blood volume is lost. This might be true for some patients under some conditions but is not necessarily true for every patient. ⋯ Recent data showing a direct beneficial effect of hemostatic therapy on blood loss and final outcome are scarce. However, evidence exists that the amount of blood loss, presence of coagulopathy and number of transfusions needed are associated with poor outcome in bleeding patients. Although manifold articles have been published already using thrombelastography for various indications (medline research "thrombelastography", 2022 articles), further data are needed to confirm the clinical experience that this technique is an excellent tool for safe patient management.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2004
Comparative Study[Vertical infraclavicular technique of brachial plexus block].
In comparison to preceding infraclavicular methods, vertical infraclavicular blockade of the brachial plexus (VIP), as described by Kilka et al. in 1995, has quickly established itself because of the high success rates and comparatively low risks. Users define the blockade success achieved at around 85 %. However, this figure includes a more or less large number of patients who require supplementary analgesia/sedation and/or sleep induction in addition to pre-medication. ⋯ In the case of the authors of this study (longest experience), only 3.7 % of the plexus blocks were incomplete. For the use of VIP in practice it can be concluded that the optimal puncture site is often somewhat lateral to that defined by Kilka et al. By means of multiple stimulation with the aim of locating the individual fasciculi of the brachial plexus, the success of blockade, in terms of operability with unchanged low complication rates, can be considerably improved without the need for additional analgesics and/or sedation.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2004
[Along the anesthetic line: a new approach to the brachial plexus -- the subcoracoidal retrograde access].
Introduced is a new approach to the brachial plexus marked out in opposition to the common methods by some theoretical advantages. The needle is proceeded in an acute angle to the course of the plexus. Thus reduces the possibility of nerve damage. Second the insertion of catheter is simplified. The accidental puncture of the pleura is unlikely except in cases of gross deviations of the puncture instruction. In addition the plexus is hit before the musculocutaneous nerve leaves the brachial plexus. The objective of this investigation was to evaluate the usefulness of the subcoracoidal retrograde access in daily practice. Beside the influence of stimulating different fascicles or the necessity of reaching a defined low stimulation level on the success rate and effectiveness of the plexus blockade was investigated. ⋯ The described subcoracoidal retrograde access to the brachial plexus (SCREP) proved to be a safe and easy method with a low complication and high success rate compared with the known practised accesses. In contrary to other authors our findings do not support the connection either between success rate and stimulating certain fascicles nor achieving a defined lowest stimulation level.