Perioperative bleeding disorders leading to major blood losses have a severe impact on patient morbidity and mortality. Despite efficient communication with the surgical team, a profound knowledge concerning the underlying mechanisms, diagnostic possibilities and available therapeutic strategies is essential for the anesthesiologist in charge. This clinical review summarizes the preoperative assessment of the most common preexisting bleeding disorders, as well as intraoperative diagnostics and management. A special focus is set on novel point-of-care tests, such as viscoelastic coagulation assays that allow rapid and precise bedside analysis of different blood clotting components. As anticoagulants and antiplatelet drugs are broadly established in everyday clinical practice, pharmacological profiles of the most common substances are highly relevant in order to provide the patient with a safe perioperative setting - including novel oral anticoagulants. Structured checklists, as introduced in this article, may help to facilitate clinical decision making during perioperative bleedings.
Die Behandlung von Blutungen im Rahmen einer Operation ist eine der Kernaufgaben des Anästhesisten. Neben der ständigen Kommunikation mit dem Operateur ist hierfür ein fundiertes Verständnis der vielfältigen Ursachen essenziell, um einen schnellstmöglichen Behandlungserfolg zu erzielen. Der Beitrag stellt die wichtigsten Zusammenhänge zur Diagnostik und Therapie perioperativer Blutungen dar.
Georg Thieme Verlag KG Stuttgart · New York.