Der Anaesthesist
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Erythropoietin, the hematopoietic growth factor, is synthesised in the kidneys and liver and regulates red blood cell production. Within the last few years, recombinant DNA technology has produced synthetic erythropoietin (rhEPO). Some patients, especially Jehovah's Witnesses, will not accept blood transfusion. The perioperative administration of rhEPO increases the patients' hematocrit (HCt) to a higher than physiological level. ⋯ The case report describes perioperative management using human rhEPO in Jehovah's Witnesses. Treatment with rhEPO increases preoperative Hb levels to a point making it possible to compensate for operative blood loss. RhEPO combined with daily iron substitution may be useful in patients who refuse transfusion based on religious convictions.
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Three cases are presented dealing with rare lethal complications during the insertion of pulmonary artery catheters (PAC). Complications resulting from catheter insertion have been reported on numerous occasions; we report further examples of inadequate insertion techniques. ⋯ Based on our observations, we believe the low complication rate associated with PAC insertion has led to deviations from the normal guidelines by some physicians. Despite adequate precautions and insertion technique, iatrogenic lesions cannot be avoided in all cases because of pre-existing risk factors. For the evaluation of catheter-induced complications and the development of a risk profile, more autopsies as well as more detailed clinical documentation would be necessary.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Cost aspects in anesthesia. Propofol versus isoflurane anesthesia].
Cost control is no longer an option, but a necessity. Propofol anaesthesia is expensive, however, the true differences in comparison to volatile anaesthetics (isoflurane) are not known. ⋯ A climate of cost-consciousness and cost-containment prevails at the present time. The costs of propofol and 'standard' isoflurane anaesthesia were without differences; however, isoflurane used in a low-flow system had the lowest cost in this study. Doubts are justified, however, as to whether the choice of anaesthetic agents may considerably lower the costs of an anaesthesia department.