Die Anaesthesiologie最新文献

Communication is crucial for patient-centred treatment decisions in intensive care medicine, particularly in an interprofessional, interdisciplinary and internal hospital context. As an integral part of intensive care treatment, communication ensures that patients' individual needs and wishes regarding quality of life are taken into account.

Post-dural puncture headache (PDPH) is a frequent yet often underestimated complication of neuraxial anesthesia. The presumed mechanism involves cerebrospinal fluid loss due to accidental dural perforation, leading to intracranial hypotension and a secondary compensatory vasodilation. Meningeal irritation and neuroinflammatory processes also contribute to the complex pathophysiology. The main symptom is a severe orthostatic headache with pain exacerbation in an upright posture. This can be accompanied by neck stiffness, tinnitus, visual and other neurological disorders. Patient-specific risk factors are young age, female sex and a positive history of headaches and anesthesia-related factors include puncture needle size and design. The epidural blood patch (EBP) is the current gold standard for treatment. The occasionally considerable patient suffering and optimization of the outcomes necessitate a critical analysis of the treatment options.

Background: Jehova's Witnesses refuse the administration of allogenic blood products for religious reasons. This stance represents a special challenge for the perioperative management and requires individualized ethically sensitive and medically founded strategies. In this respect patient blood management (PBM) provides a structured and evidence-based approach for optimization of the preoperative, intraoperative and postoperative care.

Objective: Description of the current medical, ethical and legal procedure for the management of patients who refuse blood transfusions exemplified by Jehova's Witnesses and presentation of a standardized clarification model.

Material and methods: Narrative overview of current recommendations and guidelines on preoperative treatment of anemia, intraoperative coagulation treatment, autotransfusion and the legal framework of action. In addition, a questionnaire on differentiated clarification developed at the University of Bonn is presented.

Results: A timely structured management of anemia, the application of viscoelastic point of care diagnostics and the differentiated use of autologous procedures, such as mechanical autotransfusion, enable a safe perioperative treatment even in cases of refusal of allogenic blood transfusion. Legal aspects underline the binding to patient advance directives, particularly in adults able to provide informed consent. For children, the child's welfare is prioritized in emergency cases. The clarification form presented reduces uncertainties and strengthens the interdisciplinary decision making.

Conclusion: An individualized PBM concept represents an effective and ethically tenable strategy for the perioperative treatment of patients who refuse blood transfusions. It combines medical safety with respecting patient autonomy.

In October 2025 the new resuscitation guidelines of the European Resuscitation Council (ERC) were published. In the chapter on advanced life support (ALS) for adults the update emphasizes topics such as efficient ventilation with adequate chest compressions, early defibrillation, identification and treatment of reversible causes as rapidly as possible and the administration of epinephrine in cases of non-defibrillatable cardiac arrest. The aim of the guidelines is to sustainably improve survival rates after cardiac arrest through structured and evidence-based care systems.