Skip to main content
SpringerLink
Log in

Perioperatives Management bei Zeugen Jehovas

Spezielle Berücksichtigung der religiös motivierten Ablehnung von Fremdblut

Perioperative management of Jehovah’s Witness patients

Special consideration of religiously motivated refusal of allogeneic blood transfusion

  • Leitthema
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Der Glaubensgemeinschaft der Zeugen Jehovas gehören weltweit etwa 7 Mio. Menschen an, davon 165.000 Menschen in der BRD. Eine Besonderheit bei der medizinischen Behandlung von Zeugen Jehovas ist deren strikte Ablehnung einer Transfusion von Fremdblut (Erythrozyten, Thrombozyten und Plasma). Dennoch können auch Zeugen Jehovas heute von modernen Therapiekonzepten einschließlich großer Operationen profitieren, ohne ein übertrieben hohes Letalitätsrisiko eingehen zu müssen. In der vorliegenden Übersicht werden die Grundprinzipien eines auf Zeugen Jehovas fokussierten perioperativen Patientenmanagements zur Prävention einer letalen Anämie und Koagulopathie dargestellt. Diese umfassen 1) die Aufklärung des Patienten über die i. Allg. von Zeugen Jehovas akzeptierten Verfahren zur Vermeidung einer Fremdbluttransfusion, 2) die präoperative Optimierung des kardiopulmonalen Zustands des Patienten sowie die Korrektur einer präoperativen Anämie bzw. einer präoperativen Gerinnungsstörung, 3) die perioperative Gewinnung von Eigenblut, 4) die Minimierung perioperativer Blutverluste und 5) die Nutzung der natürlichen Anämietoleranz des Patienten sowie deren akute Steigerung im Fall einer lebensbedrohlichen Anämie.

Abstract

The religious organization of Jehovah’s Witnesses numbers more than 7 million members worldwide, including 165,000 members in Germany. Although Jehovah’s Witnesses strictly refuse the transfusion of allogeneic red blood cells, platelets and plasma, Jehovah’s Witness patients may nevertheless benefit from modern therapeutic concepts including major surgical procedures without facing an excessive risk of death. The present review describes the perioperative management of surgical Jehovah’s Witness patients aiming to prevent fatal anemia and coagulopathy. The cornerstones of this concept are 1) education of the patient about blood conservation techniques generally accepted by Jehovah’s Witnesses, 2) preoperative optimization of the cardiopulmonary status and correction of preoperative anemia and coagulopathy, 3) perioperative collection of autologous blood, 4) minimization of perioperative blood loss and 5) utilization of the organism’s natural anemia tolerance and its acute accentuation in the case of life-threatening anemia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Anonymus (1944) The Watchtower 362

  2. Ball AM, Winstead PS (2008) Recombinant human erythropoietin therapy in critically ill Jehovah’s Witnesses. Pharmacotherapy 28:1383–1390

    Article  CAS  PubMed  Google Scholar 

  3. Bapoje SR, Whitaker JF, Schulz T et al (2007) Preoperative evaluation of the patient with pulmonary disease. Chest 132:1637–1645

    Article  PubMed  Google Scholar 

  4. Beattie WS, Karkouti K, Wijeysundera DN, Tait G (2009) Risk associated with preoperative anemia in noncardiac surgery. Anesthesiology 110:574–581

    Article  PubMed  Google Scholar 

  5. Blackwell KE, Ross DA, Kapur P, Calcaterra TC (1993) Propofol for maintenance of general anesthesia: a technique to limit blood loss during endoscopic sinus surgery. Am J Otolaryngol 14:262–266

    Article  CAS  PubMed  Google Scholar 

  6. Bommel J van, Trouwborst A, Schwarte L et al (2002) Intestinal and cerebral oxygenation during severe isovolemic hemodilution and subsequent hyperoxic ventilation in a pig model. Anesthesiology 97:660–670

    Article  PubMed  Google Scholar 

  7. Brown JR, Birkmeyer N, O’Connor GT (2007) Meta-analysis comparing the effectiveness and adverse outcomes of antifibrinolytic agents in cardiac surgery. Circulation 115:2801–2813

    Article  CAS  PubMed  Google Scholar 

  8. Cain SM (1977) Oxygen delivery and uptake in dogs during anemic and hypoxic hypoxia. J Appl Physiol 42:228–234

    CAS  PubMed  Google Scholar 

  9. Carson JL, Duff A, Berlin JA et al (1998) Perioperative blood transfusion and postoperative mortality. JAMA 279:199–205

    Article  CAS  PubMed  Google Scholar 

  10. Carson JL, Duff A, Poses RM et al (1996) Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet 348:1055–1060

    Article  CAS  PubMed  Google Scholar 

  11. Carson JL, Noveck H, Berlin JA, Gould SA (2002) Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. Transfusion 42:812–818

    Article  PubMed  Google Scholar 

  12. Choi WS, Samman N (2008) Risks and benefits of deliberate hypotension in anaesthesia: a systematic review. Int J Oral Maxillofac Surg 37:687–703

    Article  CAS  PubMed  Google Scholar 

  13. 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 102:1194–1200

    Article  Google Scholar 

  14. Detry O, De Roover A, Delwaide J et al (2005) Liver transplantation in Jehovah’s witnesses. Transplant Int 18:929–936

    Article  Google Scholar 

  15. Dirkmann D, Hanke A, Görlinger K, Peters J (2008) Hypothermia and acidosis synergistically impair coagulation in human whole blood. Anesth Analg 106:1627–1632

    Article  PubMed  Google Scholar 

  16. Eschenhagen W (2008) Staaten. In: Der Fischer Weltalmanach 2009. Fischer, Frankfurt a.M., S 115–161

  17. Fontana JL, Welborn L, Mongan PD et al (1995) Oxygen consumption and cardiovascular function in children during profound intraoperative normovolemic hemodilution. Anesth Analg 80:219–225

    Article  CAS  PubMed  Google Scholar 

  18. Franchini M (2007) The use of desmopressin as a hemostatic agent: a concise review. Am J Hematol 82:731–735

    Article  CAS  PubMed  Google Scholar 

  19. Franchini M, Franchi M, Bergamini V et al (2008) A critical review on the use of recombinant factor VIIa in life-threatening obstetric postpartum hemorrhage. Semin Thromb Hemost 34:104–112

    Article  CAS  PubMed  Google Scholar 

  20. Fries D, Velik-Salchner C, Lindner K, Innerhofer P (2005) Gerinnungsmanagement beim Polytrauma. Anaesthesist 54:137–144

    Article  CAS  PubMed  Google Scholar 

  21. Geha AS, Baue AE (1978) Graded coronary stenosis and coronary flow during acute normovolemic anemia. World J Surg 2:645–652

    Article  CAS  PubMed  Google Scholar 

  22. Geoghegan J, Daniels JP, Moore P et al (2009) Cell salvage at caesarean section: the need for an evidence-based approach. BJOG 116:743–747

    Article  CAS  PubMed  Google Scholar 

  23. Gödje O, Gallmeier U, Schelian M et al (2006) Coagulation factor XIII reduces postoperative bleeding after coronary surgery with extracorporeal circulation. Thorac Cardiovasc Surg 54:26–33

    Article  PubMed  Google Scholar 

  24. Gogarten W, Van Aken H, Büttner J et al (2007) Rückenmarksnahe Regionalanästhesien und Thromboembolieprophylaxe/antithrombotische Medikation. Anaesthesiol Intensivmed 48:S109–S124

    Google Scholar 

  25. Gombotz H (2003) Physiologische Grenzen der Verdünnungsanämie bei Intensivpatienten. J Anaesthesiol Intensivmed 1:84–87

    Google Scholar 

  26. Goodnough LT, Shander A, Spivak JL et al (2005) Detection, evaluation and management of anemia in the elective surgical patient. Anesth Analg 101:1858–1861

    Article  PubMed  Google Scholar 

  27. Grashey R, Mathonia P, Mutschler W, Heindl B (2007) Durch Thrombelastographie gesteuertes perioperatives Gerinnungsmanagement. Unfallchirurg 110:259–263

    Article  CAS  PubMed  Google Scholar 

  28. Habib RH, Zacharias A, Schwann TA et al (2005) Role of hemodilutional anemia and transfusion during cardiopulmonary bypass in renal injury after coronary revascularization: implications on operative outcome. Crit Care Med 33:1749–1756

    Article  PubMed  Google Scholar 

  29. Habler O (2000) Kontrollierte Hypotension. Anaesthesist 49:687–689

    Article  CAS  PubMed  Google Scholar 

  30. Habler O, Meier J, Pape A et al (2006) Perioperative Anämietoleranz – Mechanismen, Einflussfaktoren, Grenzen. Anaesthesist 55:1142–1156

    Article  CAS  PubMed  Google Scholar 

  31. Habler O, Messmer K (1997) Verfahren zur Reduktion von Fremdbluttransfusionen in der operativen Medizin. Anaesthesist 46:915–926

    Article  CAS  PubMed  Google Scholar 

  32. Habler O, Pape A, Meier J, Zwißler B (2005) Künstliche Sauerstoffträger als Alternative zur Bluttransfusion. Anaesthesist 54:741–754

    Article  CAS  PubMed  Google Scholar 

  33. 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 33:467–475

    Article  CAS  PubMed  Google Scholar 

  34. Habler OP, Kleen M, Hutter J et al (1998) Iv Perflubron emulsion versus autologous transfusion in severe normovolemic anemia: effects on left ventricular perfusion and function. Res Exp Med 197:301–318

    Article  CAS  Google Scholar 

  35. Habler OP, Kleen MS, Hutter JW et al (1998) Hemodilution and iv perflubron emulsion as an alternative to blood transfusion: effects on tissue oxygenation during profound hemodilution in anesthetized dogs. Transfusion 38:145–155

    Article  CAS  PubMed  Google Scholar 

  36. Habler OP, Kleen MS, Hutter JW et al (1998) Effects of hyperoxic ventilation on hemodilution-induced changes in anesthetized dogs. Transfusion 38:135–144

    Article  CAS  PubMed  Google Scholar 

  37. Hagl S, Heimisch W, Meisner H et al (1974) The effect of hemodilution on regional myocardial function in the presence of coronary stenosis. Basic Res Cardiol 72:344–364

    Article  Google Scholar 

  38. Hebert PC, Wells G, Blajchman MA et al (1999) A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 340:409–417

    Article  CAS  PubMed  Google Scholar 

  39. Hiippala ST, Myllylä GJ, Vahtera EM (1995) Hemostatic factors and replacement of major blood loss with plasma-poor red cell concentrates. Anesth Analg 81:360–365

    Article  CAS  PubMed  Google Scholar 

  40. Jabbour N, Gagandeep S, Cheng PA et al (2005) Recombinant coagulation factor VIIa in Jehovah’s Witness patients undergoing liver transplantation. Am Surg 71:175–179

    PubMed  Google Scholar 

  41. Jabbour N, Gagandeep S, Mateo R et al (2005) Transfusion free surgery: single institution experience of 27 consecutive liver transplants in Jehovah’s Witnesses. J Am Coll Surg 201:412–417

    Article  PubMed  Google Scholar 

  42. Jeffrey GP, McCall J, Gane E et al (2007) Liver transplantation in Jehovah’s Witness patients in Australasia. Med J Aust 187:188–189

    PubMed  Google Scholar 

  43. Johannes T, Mik EG, Nohe B et al (2007) Acute decrease in renal microvascular pO2 during acute normovolemic hemodilution. Am J Physiol Renal Physiol 292:F796–F803

    Article  CAS  PubMed  Google Scholar 

  44. Jones R, Moulton CE, Hardy KJ (1998) Central venous pressure and its effects on blood loss during liver resection. Br J Surg 85:1058–1060

    Article  CAS  PubMed  Google Scholar 

  45. Katz DM, Trobe JD, Cornblath WT, Kline LB (1994) Ischemic optic neuropathy after lumbar spine surgery. Arch Ophthalmol 112:925–931

    CAS  PubMed  Google Scholar 

  46. Kemming GI, Meisner FG, Kleen M et al (2004) Hyperoxic ventilation in critical dilutional anemia: intestinal O2 transport and tissue oxygenation. Transfus Altern Transfus Med 5:523–529

    Article  Google Scholar 

  47. Kemming GI, Meisner FG, Kleen M et al (2003) Hyperoxic ventilation at the critical hematocrit. Resuscitation 56:289–297

    Article  CAS  PubMed  Google Scholar 

  48. Kemming GI, Meisner FG, Meier J et al (2004) Hyperoxic ventilation at the critical hematocrit: effects on myocardial perfusion and function. Acta Anaesth Scand 48:951–959

    Article  CAS  PubMed  Google Scholar 

  49. Koscielny J, Ziemer S, Radtke H et al (2007) Preoperative identification of patients with impaired (primary) haemostasis. A practical concept. Haemostaseologie 27:177–184

    CAS  Google Scholar 

  50. Kutschker S, Pape A, Kertscho H et al (2007) The tolerance of acute normovolemic anemia depends on the choice of the plasma substitute. Eur J Anaesth 24 [Suppl 39]:65

    Google Scholar 

  51. Levi M, Jonge E (2007) Clinical relevance of the effects of plasma expanders on coagulation. Semin Thromb Hemost 33:810–815

    Article  CAS  PubMed  Google Scholar 

  52. Levy PS, Kim SJ, Eckel PK et al (1993) Limit to cardiac compensation during acute normovolemic hemodilution: influence of coronary stenosis. Am J Physiol 265:H340–H349

    CAS  PubMed  Google Scholar 

  53. Lieberman JA, Weiskopf RB, Kelley SD et al (2000) Critical oxygen delivery in conscious humans is less than 7.3 ml O2 × kg(−1) × min(−1). Anesthesiology 92:407–413

    Article  CAS  PubMed  Google Scholar 

  54. Linden P van der, De Hert S, Mathieu N et al (2003) Tolerance to acute isovolemic hemodilution. Effect of anesthetic depth. Anesthesiology 99:97–104

    Article  PubMed  Google Scholar 

  55. Linden P van der, Engelman E, Schmartz D, Vincent JL (1991) Effects of anesthetic agents on systemic critical O2 delivery. J Appl Physiol 71:83–93

    PubMed  Google Scholar 

  56. Linden P van der, Schmartz D, De Groote F et al (1998) Critical hemoglobin concentration in anesthetized dogs: comparison of two plasma substitutes. Br J Anaesth 81:556–562

    PubMed  Google Scholar 

  57. Linden P van der, Schmartz D, Gilbart E et al (2000) Effects of propofol, etomidate and pentobarbital on critical oxygen delivery. Crit Care Med 28:2492–2499

    Article  PubMed  Google Scholar 

  58. Lossen M, Pape A, Kertscho H et al (2007) Continuous neuromuscular blockade with rocuronium bromide increases the tolerance of acute normovolemic anemia in anesthetised domestic pigs. Eur J Anaesth 24 [Suppl 39]:111

  59. Martini WZ, Dubick MA, Wade CE, Holcomb JB (2007) Evaluation of tris-hydroxymethylaminomethane on reversing coagulation abnormalities caused by acidosis in pigs. Crit Care Med 35:1568–1574

    Article  CAS  PubMed  Google Scholar 

  60. 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 103:1018–1025

    Article  PubMed  Google Scholar 

  61. McLoughlin TM, Fontana JL, Alving B et al (1996) Profound normovolemic hemodilution: hemostatic effects in patients and in a porcine model. Anesth Analg 83:459–465

    Article  CAS  PubMed  Google Scholar 

  62. Meier J, Kemming G, Meisner F et al (2005) Hyperoxic ventilation enables hemodilution beyond the critical myocardial hemoglobin concentration. Eur J Med Res 10:462–468

    CAS  PubMed  Google Scholar 

  63. Meier J, Kemming GI, Kisch-Wedel H et al (2004) Hyperoxic ventilation reduces 6-hour mortality at the critical hemoglobin concentration. Anesthesiology 100:70–76

    Article  CAS  PubMed  Google Scholar 

  64. Meier J, Pape A, Loniewska D et al (2007) Norepinephrine increases tolerance to acute anemia. Crit Care Med 35:1484–1492

    Article  CAS  PubMed  Google Scholar 

  65. Meisner FG, Kemming GI, Habler OP et al (2001) Diaspirin crosslinked hemoglobin enables extreme hemodilution beyond the critical hematocrit. Crit Care Med 29:829–838

    Article  CAS  PubMed  Google Scholar 

  66. Meng ZH, Wolberg AS, Monroe DM, Hoffman M (2003) The effect of temperature and pH on the activity of factor VIIa: implications for the efficacy of high-dose factor VIIa in hypothermic and acidotic patients. J Trauma 55:886–891

    Article  CAS  PubMed  Google Scholar 

  67. Nagarsheth NP, Shander A, Malovany R et al (2007) Bloodless surgery in a Jehovah’s Witness patient with a 12.7-kg uterine leiomyosarcoma. J Surg Educ 64:212–219

    Article  PubMed  Google Scholar 

  68. Nelson CL, Bowen WS (1995) Total hip arthroplasty in Jehovah’s Witnesses without blood transfusion. J Bone Joint Surg 68:350–353

    Google Scholar 

  69. Pape A, Meier J, Kertscho H et al (2006) Hyperoxic ventilation increases the tolerance of acute normovolemic anemia in anesthetized pigs. Crit Care Med 34:1475–1482

    Article  CAS  PubMed  Google Scholar 

  70. Paulone ME, Edelstone DI, Shedd A (1987) Effects of maternal anemia on uteroplacental and fetal oxidative metabolism in sheep. Am J Obstet Gynecol 156:230–237

    CAS  PubMed  Google Scholar 

  71. Perez-de-Sa V, Roscher R, Cunha-Goncalves D et al (2002) Mild hypothermia has minimal effects on the tolerance to severe progressive normovolemic anemia in swine. Anesthesiology 97:1189–1197

    Article  PubMed  Google Scholar 

  72. Rahman IA, Hoth T, Doughty H, Bonser RS (2007) Thoraco-abdominal aneurysm repair in a Jehovah’s Witness: maximising blood conservation. Perfusion 22:363–364

    Article  CAS  PubMed  Google Scholar 

  73. Ranucci M, Romitti F, Isgro G et al (2005) Oxygen delivery during cardiopulmonary bypass and acute renal failure after coronary operations. Ann Thorac Surg 80:2213–2220

    Article  PubMed  Google Scholar 

  74. Samama CM (2008) Prothrombin complex concentrates: a brief review. Eur J Anaesth 25:784–789

    Article  CAS  Google Scholar 

  75. Schaller RT, Schaller J, Furman EB (1984) The advantages of hemodilution anesthesia for major liver resection in children. J Pediatr Surg 19:705–710

    Article  PubMed  Google Scholar 

  76. Scheingraber S, Rehm M, Sehmisch C, Finsterer U (1999) Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Anesthesiology 90:1265–1270

    Article  CAS  PubMed  Google Scholar 

  77. Schmied H, Kurz A, Sessler DI et al (1996) Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet 347:289–292

    Article  CAS  PubMed  Google Scholar 

  78. Schou H, Kongstad L, Perez de Sa V et al (1998) Uncompensated blood loss is not tolerated during acute normovolemic hemodilution in anesthetized pigs. Anesth Analg 87:786–794

    Article  CAS  PubMed  Google Scholar 

  79. Shander A, Goodnough LT (2009) Why an alternative to blood transfusion? Crit Care Clin 25:261–277

    Article  PubMed  Google Scholar 

  80. Shander A, Knight K, Thurer R et al (2004) Prevalence and outcome of anemia in surgery: a systematic review of the literature. Am J Med 116:58S–69S

    Article  PubMed  Google Scholar 

  81. Spahn DR, Bremt R van, Theilmeier G et al (1999) The European perflubron emulsion study group. Perflubron emulsion delays blood transfusions in orthopedic surgery. Anesthesiology 91:1195–1208

    Article  CAS  PubMed  Google Scholar 

  82. Steuer W, Dreuw H (2008) Hämotherapie und Glaube. Religion Staat Gesellschaft 9:137–158

    Google Scholar 

  83. Suttner S, Piper SN, Kumle B et al (2004) The influence of allogeneic red blood cell transfusion compared with 100% oxygen ventilation on systemic oxygen transport and skeletal muscle oxygen tension after cardiac surgery. Anesth Analg 99:2–11

    Article  PubMed  Google Scholar 

  84. Tanaka K, Waly AA, Cooper WA, Levy JH (2003) Treatment of excessive bleeding in Jehovah’s Witness patients after cardiac surgery with recombinant factor VIIa (NovoSeven®). Anesthesiology 1513–1515

  85. Ulsenheimer K (2010) Juristische Aspekte (…) Zeugen Jehovas. Anaesthesist #:#–#

  86. Vamvakas EC, Blajchman MA (2009) Transfusion-related mortality: the ongoing risks of allogeneic transfusion and the available strategies for their prevention. Blood 113:3406–3417

    Article  CAS  PubMed  Google Scholar 

  87. Vernon D, Witte M (2000) Effect of neuromuscular blockade on oxygen consumption and energy expenditure in sedated, mechanically ventilated children. Crit Care Med 28:1569–1571

    Article  CAS  PubMed  Google Scholar 

  88. Viele MK, Weiskopf RB (1994) What can we learn about the need for transfusion from patients who refuse blood? The experience with Jehovah’s Witnesses. Transfusion 34:396–401

    Article  CAS  PubMed  Google Scholar 

  89. Vincent JL, Baron J-F, Reinhart K et al (2002) Anemia and blood transfusion in critically ill patients. JAMA 288:1499–1507

    Article  PubMed  Google Scholar 

  90. Weinkove R, Rangarajan S (2008) Fibrinogen concentrate for acquired hypofibrinogenaemic states. Transfus Med 18:151–157

    Article  CAS  PubMed  Google Scholar 

  91. Weiskopf RB, Feiner J, Hopf HW et al (2002) Oxygen reverses deficits of cognitive function and memory and increased heart rate induced by acute severe isovolemic anemia. Anesthesiology 96:871–877

    Article  PubMed  Google Scholar 

  92. Weiskopf RB, Toy P, Hopf HW et al (2005) Acute isovolemic anemia impairs central processing as determined by P300 latency. Clin Neurophysiol 116:1028–1032

    Article  PubMed  Google Scholar 

  93. Woerkens ECSM van, Trouwborst A, Van Lanschot JJB (1992) Profound hemodilution: What is the critical level of hemodilution at which oxygen delivery-dependent oxygen consumption starts in an anesthetized human. Anesth Analg 75:818–821

    PubMed  Google Scholar 

  94. Wu W-C, Schifftner TL, Henderson WG et al (2007) Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. JAMA 297:2481–2488

    Article  CAS  PubMed  Google Scholar 

  95. Yagmur E, Piatkowski A, Gröger A et al (2005) Bleeding complication under Gingko biloba medication. Am J Hematol 79:343–345

    Article  CAS  PubMed  Google Scholar 

  96. Zollinger A, Hager P, Singer T et al (1997) Extreme hemodilution due to massive blood loss in tumor surgery. Anesthesiology 87:985–987

    Article  CAS  PubMed  Google Scholar 

  97. Zwißler B (2008) Präoperative Voruntersuchung bei kardialen Risikopatienten für nichtherzchirurgische Eingriffe. Neue Leitlinien der ACC/AHA 2007. Anaesthesist 57:717–719

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht

Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie, Operative Intensivmedizin und Schmerztherapie, Krankenhaus Nordwest GmbH, Steinbacher Hohl 2–26, 60488, Frankfurt am Main, Deutschland

    O. Habler & B. Voß

Authors
  1. O. Habler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Voß
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to O. Habler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Habler, O., Voß, B. Perioperatives Management bei Zeugen Jehovas. Anaesthesist 59, 297–311 (2010). https://doi.org/10.1007/s00101-010-1701-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-010-1701-2

Schlüsselwörter

Keywords

Search

Navigation