Intraoperativer Volumenersatz, Transfusion und Behandlung von Gerinnungsstörungen

  • Oliver Habler


Sowohl der operative Eingriff als auch die Narkose führen zu Veränderungen des intravasalen Volumenstatus des Patienten.


  1. 1.
    American Society of Anesthesiologists (2006) Practice guidelines for blood transfusion and adjuvant therapies. Anesthesiology 105: 198–208CrossRefGoogle Scholar
  2. 2.
    Atzil S, Arad M, Glasner A et al. (2008) Blood transfusion promotes cancer progression: a critical role for aged erythrocytes. Anesthesiology 109: 989–997PubMedCrossRefGoogle Scholar
  3. 3.
    Bryson GL, Laupacis A, Wells GA for the International Study of Perioperative Transfusion (1998) Does acute normovolemic hemodilution reduce perioperative allogeneic transfusion? A Meta-analysis. Anesth Analg 86: 9–15PubMedGoogle Scholar
  4. 4.
    Bundesärztekammer auf Empfehlung ihres wissenschaftlichen Beirates (2009) Querschnittsleitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten. 4. überarbeitete Auflage, Deutscher Ärzteverlag, KölnGoogle Scholar
  5. 5.
    Bunn HF, May MH, Kochalaty WF, Shields CE (1969) Hemoglobin function in stored blood. J Clin Invest 48:311–321PubMedCrossRefGoogle Scholar
  6. 6.
    Carless PA, Hentry DA, Moxey AJ et al. (2010) Cell salvage for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 4: CD001888PubMedGoogle Scholar
  7. 7.
    Carson JL, Duff A, Poses RM et al. (1996) Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet 348: 1055–1060PubMedCrossRefGoogle Scholar
  8. 8.
    Choi WS, Samman N (2008) Risks and benefits of deliberate hypotension in anaesthesia: a systematic review. Int J Oral Maxillofac Surg 37: 687–703PubMedCrossRefGoogle Scholar
  9. 9.
    College of American Pathologists (1998) Practice parameter for the use of red blood cell transfusions. Arch Pathol Lab Med 122: 130–138Google Scholar
  10. 10.
    De Lorenzo C, Calatzis A, Welsch U, Heindl B (2006) Fibrinogen concentrate reverses dilutional coagulopathy induced in vitro by saline but not by hydroxyethyl starch 6 %. Anesth Analg 102: 1194–1200PubMedCrossRefGoogle Scholar
  11. 11.
    Dirkmann D, Hanke A, Görlinger K, Peters J (2008) Hypothermia and acidosis synergistically impair coagulation in human whole blood. Anesth Analg 106: 1627–1632PubMedCrossRefGoogle Scholar
  12. 12.
    Dunham CM, Siegel JH, Weireter L et al. (1991) Oxygen debt and metabolic acedemia as quantitative predictors of mortality and the severity of the ischemic insult in hemorrhagic shock. Crit Care Med 19: 231–243PubMedCrossRefGoogle Scholar
  13. 13.
    Egli GA, Zollinger A, Seifert B et al. (1997) Effect of progressive haemodilution with hydroxyethyl starch, gelatin and albumin on blood coagulation. Br J Anaesth 78: 684–689PubMedCrossRefGoogle Scholar
  14. 14.
    Endrich B, Franke N, Peter K, Messmer K (1987) Induced hypotension: action of sodium nitroprusside and nitroglycerin on the microcirculation. Anesthesiology 66: 605–613PubMedCrossRefGoogle Scholar
  15. 15.
    European Commission (Sirchia G, Giovanetti AM, McClelland B, Fraccia GN) (1994) Safe and good use of blood in surgery (SANGUIS). Use of blood products and artificial colloids in 43 European hospitals. European Commission, LuxembourgGoogle Scholar
  16. 16.
    Fergusson DA, Hebert PC, Mazer CD et al. (2008) A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med 358: 2319–2331PubMedCrossRefGoogle Scholar
  17. 17.
    Fitzgerald RD, Martin CM, Dietz GE et al. (1997) Transfusing red blood cells stored in citrate phosphate dextrose adenine-1 for 28 days fails to improve tissue oxygenation in rats. Crit Care Med 25: 726–732PubMedCrossRefGoogle Scholar
  18. 18.
    Friedman BA, Oberman HA, Chadwick AR, Kingdon KI (1976) The maximum surgical blood order schedule and surgical blood use in the United States. Transfusion 16: 380–387PubMedCrossRefGoogle Scholar
  19. 19.
    Gajic O, Gropper MA, Hubmayr RD (2006) Pulmonary edema after transfusion: how to differentiate transfusion-associated circulatory overload from transfusion-related acute lung injury. Crit Care Med 34: S109–S113PubMedCrossRefGoogle Scholar
  20. 20.
    Geoghegan J, Daniels JP, Moore P et al. (2009) Cell salvage at caesarean section: the need for an evidence-based approach. BJOG 116: 743–747PubMedCrossRefGoogle Scholar
  21. 21.
    Gogarten W, Van Aken H, Büttner J et al. (2007) Rückenmarksnahe Regionalanästhesien und Thromboembolieprophylaxe/antithrombotische Medikation. Anästh Intensivmed 48: S109–S124Google Scholar
  22. 22.
    Gombotz H (2003) Physiologische Grenzen der Verdünnungsanämie bei Intensivpatienten. J Anästh Intensivmed 1: 84–87Google Scholar
  23. 23.
    Goodnough LT, Maniatis A, Earnshaw P et al. (2011) Detection, evaluation and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines. Br J Anaesth 106: 13–22PubMedCrossRefGoogle Scholar
  24. 24.
    Grashey R, Mathonia P, Mutschler W, Heindl B (2007) Durch Thrombelastographie gesteuertes perioperatives Gerinnungsmanagement. Unfallchirurg 110: 259–263PubMedCrossRefGoogle Scholar
  25. 25.
    Habler O, Meier J, Pape A et al. (2006) Perioperative Anämietoleranz – Mechanismen, Einflussfaktoren, Grenzen. Anaesthesist 55: 1142–1156PubMedCrossRefGoogle Scholar
  26. 26.
    Habler O, Pape A, Meier J, Zwißler B (2005) Künstliche Sauerstoffträger als Alternative zur Bluttransfusion. Anaesthesist 54: 741–754PubMedCrossRefGoogle Scholar
  27. 27.
    Habler O, Schwenzer K, Zimmer K et al. (2004) Effects of standardized acute normovolemic hemodilution on intraoperative allogeneic blood transfusion in patients undergoing major maxillofacial surgery. Int J Oral Maxillofac Surg 33: 467–475PubMedCrossRefGoogle Scholar
  28. 28.
    Habler O, Voß B (2010) Perioperatives Management bei Zeugen Jehovas. Anaesthesist 59: 297–311PubMedCrossRefGoogle Scholar
  29. 29.
    Hansen E, Knuechel R, Altmeppen J, Taeger K (1999) Blood irradiation for intraoperative autotransfusion in cancer surgery: demonstration of efficient elimination of contaminating tumor cells. Transfusion 39: 608–615PubMedCrossRefGoogle Scholar
  30. 30.
    Heiss MM, Mempel W, Delanoff C et al. (1994) Blood transfusion-modulated tumor recurrence: first results of a randomized study of autologous versus allogeneic blood transfusion in colorectal cancer surgery. J Clin Oncol 12: 1859–1867PubMedGoogle Scholar
  31. 31.
    Hiippala ST, Myllylä GJ, Vahtera EM (1995) Hemostatic factors and replacement of major blood loss with plasma-poor red cell concentrates. Anesth Analg 81: 360–365PubMedGoogle Scholar
  32. 32.
    Hourfar MK, Jork C, Schottstedt V et al. (2008) Experience of German Red Cross blood donor services with nucleic acid testing: results of screening more than 30 million blood donations for human immunodeficiency virus-1, hepatitis C virus and hepatitis B virus. Transfusion 48: 1558–1566PubMedCrossRefGoogle Scholar
  33. 33.
    Jones R, Moulton CE, Hardy KJ (1998) Central venous pressure and its effects on blood loss during liver resection. Br J Surg 85:1058–1060PubMedCrossRefGoogle Scholar
  34. 34.
    Karger R, Kretschmer V, Wulf H (2004) Risiken der Transfusion von Blutkomponenten: Aktuelle Anhaltszahlen für eine «quantitative” Risikoaufklärung. Anästh Intensivmed 45:430–434Google Scholar
  35. 35.
    Kick O, Daniel E (1997) Mathematical considerations in the practice of acute normovolemic hemodilution. Transfusion 37: 141–143PubMedCrossRefGoogle Scholar
  36. 36.
    Koch CG, Li L, Sessler DI et al. (2008) Duration of red-cell storage and complications after cardiac surgery. N Engl J Med 358: 1229–1239PubMedCrossRefGoogle Scholar
  37. 37.
    Koscielny J, Ziemer S, Radtke H et al. (2007) Preoperative identification of patients with impaired (primary) haemostasis. A practical concept. Haemostaseologie 27: 177–184Google Scholar
  38. 38.
    Kurz A, Sessler DI, Lenhard R (1996) Perioperative normothermia to reduce the incidence of surgical wound infection and shorten hospitalization. N Engl J Med 334: 1209–1215PubMedCrossRefGoogle Scholar
  39. 39.
    Marik PE, Baram M, Vahid B (2008) Does the central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of the seven mares. Chest : 172–178Google Scholar
  40. 40.
    Marik PE, Sibbald WJ (1993) Effects of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA 269: 3024–3029PubMedCrossRefGoogle Scholar
  41. 41.
    Mauermann WJ, Shilling AM, Zuo Z (2006) A comparison of neuroaxial block versus general anesthesia for elective total hip replacement: a meta-analysis. Anesth Analg 103: 1018–1025PubMedCrossRefGoogle Scholar
  42. 42.
    Mielke LL, Entholzner EK, Kling M et al. (1997) Preoperative acute hypervolemic hemodilution with hydroxyethylstarch: an alternative to acute normovolemic hemodilution? Anesth Analg 84: 26–30PubMedGoogle Scholar
  43. 43.
    Monk TG, Goodnough LT, Brecher ME et al. (1999) A prospective randomized comparison of three blood conservation strategies for radical prostatectomy. Anesthesiology 91: 24–33PubMedCrossRefGoogle Scholar
  44. 44.
    Moore SB (2006) Transfusion-related acute lung injury (TRALI): clinical presentation, treatment, and prognosis. Crit Care Med 34: S114–S117PubMedCrossRefGoogle Scholar
  45. 45.
    Penner M, Sibrowski W (1994) Nutzen und Risiken der Eigenblutspende. Infusionsther Transfusionsmed 21 (suppl 1): 64–68PubMedGoogle Scholar
  46. 46.
    Roback JD, Caldwell S, Carson J et al. (2010) Evidence-based practice guidelines for plasma transfusion. Transfusion 50: 1227–1239PubMedCrossRefGoogle Scholar
  47. 47.
    Scheingraber S, Rehm M, Sehmisch C, Finsterer U (1999) Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Anesthesiology 90: 1265–1270PubMedCrossRefGoogle Scholar
  48. 48.
    Segal JB, Blasco-Colmenares E, Norris EJ, Guallar E (2004) Preoperative acute normovolemic hemodilution: a meta-analysis. Transfusion 44: 632–644PubMedCrossRefGoogle Scholar
  49. 49.
    Shander A, Hofmann A, Ozawa S et al. (2010) Activity-based costs of blood transfusions in surgical patients at four hospitals. Transfusion 50: 753–765PubMedCrossRefGoogle Scholar
  50. 50.
    Staab DB, Sorensen VJ, Fath JJ et al. (1999) Coagulation defects resulting from ambient temperature-induced hypothermia. J Trauma 36: 634–638CrossRefGoogle Scholar
  51. 51.
    Taylor RW, O‘Brian J, Trottier SJ et al. (2006) Red blood cell transfusions and nosocomial infections in critically ill patients. Crit Care Med 34: 2302–2308PubMedCrossRefGoogle Scholar
  52. 52.
    Thomas MJG, Gillon J, Desmond MJ (1996) Preoperative Autologous Donation. Transfusion 36: 633–639PubMedCrossRefGoogle Scholar
  53. 53.
    Vamvakas EC and Blajchman MA (2010) Blood still kills: six strategies to further reduce allogeneic blood transfusion-related mortality. Transf Med Rev 24: 77–124CrossRefGoogle Scholar
  54. 54.
    Van Daele MERM, Trouwborst A, Van Woerkens LCSM et al. (1994) Transoesophageal echocardiographic monitoring of preoperative acute hypervolemic hemodilution. Anesthesiology 81: 602–609PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Oliver Habler
    • 1
  1. 1.Klinik für Anästhesiologie, operative Intensivmedizin und SchmerztherapieKrankenhaus NordwestFrankfurt

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