Der Anaesthesist
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German post-mortem organ donation rates have been declining since 2010. Several transplantation scandals led to a negative portrayal of organ donation in the media. Spain, the UK and the Netherlands achieved a rise in organ donation rates while retaining organ donation legislation. ⋯ Donation after cardiac death (DCD), expanded donor criteria, increasing public awareness and introduction of an organ donor register should be discussed as measures to increase organ donation rates in Germany.
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Plasmatic coagulation disorders in trauma patients are common and their management is subject to current guidelines. Less evidence exists for platelet function. Although it is known that several trauma-associated factors have a negative influence on platelet function, routine monitoring has not yet become established. ⋯ Approximately one quarter to one third of primarily admitted trauma patients without long-term anticoagulation medication showed a delayed platelet activation in the PFA-100 test. By considering all trauma patients an even higher rate can be expected. The Hb and fibrinogen levels at admission can be helpful to estimate platelet disorders. The development of platelet assays to guide the resuscitation of individual patients seems to be absolutely necessary. The contribution of platelet disorders to trauma-induced coagulopathy is not sufficiently understood. Regarding the importance assigned to platelet transfusion or administration of desmopressin, these aspects should be the subject of further research.
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Liver transplantation (LTPL) is the only curative option for patients with end stage liver disease (ESLD) or with hepatocellular carcinoma (HCC). Eurotransplant in Leiden, the Netherlands, is responsible for organ allocation. The model of end stage liver disease (MELD) score, which describes the severity of the liver disease, is decisive for organ allocation. ⋯ The anesthesiologist is responsible for evaluating the overall prognosis, whereby cardiac, pulmonary, renal and neurological comorbidities must be taken into consideration. During LTPL surgery is divided into several stages. Besides volume management, heat preservation and coagulation management, major challenges for the anesthesiologist are hemodynamic stabilization and regulation of the acid-base balance.
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Infusion sets with precision flow regulators are frequently used in children undergoing surgery in order to control the perioperative administration of fluids. There are no data about the safety and accuracy of these infusion sets. A study was therefore conducted to compare adjusted and actual flow rates of three different infusion sets with precision flow regulators under standardized conditions. ⋯ The actual flow rates differed considerably from the adjusted flow rates in the evaluated infusion sets. The flow rates substantially depended on the static level of the infusion. First and foremost, regulation of the administered infusion volume does not seem to be reliable when using an infusion set with a precision flow regulator.
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Skills shortage of nursing staff and physicians is a "hot topic" in health politics. For the future recruitment of medical staff in anesthesiology, an analysis of the staff development during the last decades considering gender aspects seems to be important. Therefore, the authors conducted a comparative analysis of data from the "Statistisches Bundesamt" (Fachserie 12 Reihe 7.3.1 and Fachserie 12 Reihe 6.1.1.) from 1994 until 2015. ⋯ Anesthesiology is a discipline in which both the number of tasks and personnel have risen over the last two decades. The comparatively huge increase in the number of residents and consultants without management tasks suggests that the number of tasks in daily routine has substantially increased for anesthesiologists. The comparatively low percentage of female colleagues in chair positions should give an impulse to improve the compatibility of family and working live both for clinical and scientific careers.