Der Anaesthesist
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Review
[Venous thrombosis and pulmonary embolism : Updated S2 guidelines on diagnostics and therapy].
The updated version of the S2k guidelines on diagnostics and therapy of venous thrombosis and pulmonary embolism have been available since the end of last year. The guidelines deal with the advantages and disadvantages of the currently available investigation and treatment methods, the diagnostic sequence of investigations under various clinical conditions, the invasiveness and duration of therapies and the potential special features of vulnerable patient collectives. This article presents a summary of the most important assertions.
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In Germany approximately 4-5 million erythrocyte concentrates are administered annually. Every transfusion fulfills the criteria for an organ transplantation and represents a measure that includes risks which must be clarified with informed consent. This article describes the legal requirements for informed consent, the content, form and the exceptions. Finally, the consequences of errors in informed consent are presented.
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Peripartum hemorrhage (PPH) is a frequent obstetric emergency situation with increasing incidence in the last decades. It requires a fast, coordinated and interdisciplinary management. This life-threatening situation is often recognized too late and not adequately treated (too little is done too late); therefore, it is important to be aware of the most important risk factors for PPH known as the 4 Ts (i.e. tonus, trauma, tissue and thrombin). Due to the special patient population there is only little evidence-based data on hemostatic therapy in this situation; therefore, the currently available studies on the therapy of PPH is discussed.
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Despite substantial success in the anesthetic and surgical management of cardiac surgery, patients frequently show postoperative complications and organ dysfunctions. This is highly relevant for mid- to long-term outcomes. ⋯ Beside the use of cardioplegia and hypothermia, the use of volatile anesthetics is well-established during cardiac surgery because of its conditioning and protective properties. Regardless of the promising results derived from experimental studies and small clinical trials, the majority of other approaches failed to translate their findings into the clinic. Therefore, systematic experimental studies are needed to identify potential confounding factors that may affect the protective effects.