Der Anaesthesist
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Suicide rates of male and female physicians are about 3-5 times higher compared with the general public. Detailed studies about medical student suicides in the United States exist but similar current data from German speaking countries are lacking. ⋯ The suicide risk of medical students at the Medical University of Innsbruck appears to be increased. Because of a lack of comparable data it is not possible to show whether these observations can be extrapolated to other universities. It appears that there was no single special event which triggered suicide by the medical students but a combination of individual risk factors and the environment was involved. However, this problem receives insufficient attention.
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This study investigated the influence of the oral direct inhibitor of factor Xa rivaroxaban on blood coagulation measured by rotation thrombelastometry ROTEM™. Blood was obtained from 11 healthy male volunteers before and 2.5 h after oral administration of 10 mg rivaroxaban. In addition to standard coagulation tests clot formation was measured by ROTEM™ analyzing extrinsic (Extem) and intrinsic thrombelastometry (Intem). ⋯ The receiver operating characteristic curve (ROC) analysis determined aPTT to be the most appropriate parameter for the prediction of rivaroxaban-induced anticoagulation, Intem-CT and Extem-CT proved to be moderate tests and PT had no significance in the prediction of rivaroxaban-induced anticoagulation. Of utmost clinical importance was the fact that rivaroxaban treated patients could still show normal ROTEM™ values. Thus, ROTEM™ cannot be a suitable test method to exclude inhibition of blood coagulation by rivaroxaban.
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Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) may have a significant impact on physiological functions and is therefore a special challenge for anesthetists. In the presented case after opening the parietal pleura during subphrenical peritonectomy the HIPEC solution accidentally leaked into the right hemithorax with subsequent pleural effusion of more than 2,000 ml. ⋯ Following pleural sonography and chest X-ray in the operating theatre and recovery area, a thorax drainage was inserted into the pleural space and ventilation support was provided by non-invasive continuous positive air pressure (CPAP) ventilation. With reference to recent publications the anesthesiological management of patients undergoing HIPEC is presented.
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This article reports the successful use of C1 esterase inhibitor in the treatment of capillary leak syndrome. The coincidence of exposure to latex during surgery and medication with ramipril led to prolonged shock complicated by secondary hyperfibrinolysis, capillary leak syndrome and multiple organ failure. Initial treatment according to relevant guidelines failed to stabilize the condition. Treatment was only successful after administration of 1,500 IU of human C1 esterase inhibitor.