Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2025
Review[Red Blood Cell Transfusion - Indications, Informed Consent and Associated Risks].
The aim of red blood cell (RBC) transfusion is to prevent or treat anemic tissue hypoxia in acute or chronic anemia. In 2022, approximately 3.2 million red blood cell transfusions were conducted in Germany. ⋯ Blood loss in particular increases the risk of an imbalance between oxygen supply and oxygen demand. Targeted, rational (restrictive) blood transfusion based on physiological transfusion triggers makes it possible to avoid organ injury due to anemic hypoxia.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2025
Review[Platelet Concentrates - Indication, Informed Consent, Transfusion and Adverse Events].
Transfusion of platelet concentrates (PC) can be a life-saving measure in case of severe thrombocytopenia or thrombocytopathy, particularly in bleeding patients. Although acaryote, platelets are involved in several important functions including immunomodulation, but their most important function is in primary and secondary haemostasis. In this German review, apheresis and whole blood derived PC are compared and indications as well as transfusion triggers and dosage of PC are discussed. ⋯ Therefore, the treating physician should be aware of the potential adverse events and their prophylaxis in order to best advise the patient. Eight of the most prevalent and/or clinically severe adverse events following PC transfusion and their handling and prevention are discussed. In addition, practical aspects of PC transfusion are depicted as well as the treating physician's choice of the appropriate PC including a flowchart for refractory patients.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2025
Review[Transfusion of Fresh Frozen Plasma and Coagulation Factors - Indications, Practice and Complications].
After severe trauma, but also perioperatively, massive bleeding is associated with increased morbidity and mortality. In severely injured patients, hemorrhagic shock remains to be the main cause of death in addition to traumatic brain hemorrhage. In non-cardiac surgery, a surgical bleeding complication increases perioperative morbidity (intensive care length of stay, acute renal failure, infections, thromboembolic complications) by a factor of three to four and mortality by a factor of six. ⋯ This practice of untargeted coagulation therapy is mainly used in the USA and some Scandinavian countries. Mortality is significantly worse in the USA than in central Europe, particularly in the case of severe injuries. There is increasing evidence that targeted coagulation therapy with coagulation factor concentrates based on the results of point-of-care coagulation diagnostics is more effective and associated with fewer transfusion- and bleeding-related complications.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2025
[Anaesthesia Technical Assistants (ATA) in the Recovery Room].
For two years now, anaesthesia technical assistance has been a state-recognized profession in Germany and entitles graduates to work in all fields of anaesthesiology, with the exception of the intensive care unit. The job profile is comparable to the nurse anesthetist in Great Britain (Operation Department Practitioner) or in the Netherlands (Anesthesiemedewerker). In an initial empirical research project in 2023, the professional field was described and the question of whether graduates are adequately prepared for the fields of anaesthesiology was discussed with the focus particularly on the recovery room. ⋯ However, the study showed that training should be improved by including practical work in the intensive care unit during schooling. The existing training and examination regulations currently only offer a small amount of scope for an assignment in the intensive care unit. Therefore, the training and in particular the practical assignments should be evaluated and modified in the future.