nach oben

Die Anaesthesiologie

Erschienen in:

01.08.2005 | Leitthema

Künstliche Sauerstoffträger als Alternative zur Bluttransfusion

verfasst von: Univ.-Prof. Dr. O. Habler, A. Pape, J. Meier, B. Zwißler

Erschienen in: Die Anaesthesiologie | Ausgabe 8/2005

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die zu erwartende Kostensteigerung im Transfusionswesen (steigender Fremdblutbedarf bei gleichzeitig rückläufiger Spendebereitschaft, Behandlungspflicht transfusionsassoziierter Folgeerkrankungen) erhöht den sozioökonomischen Stellenwert der Entwicklung synthetischer Sauerstoffträger als Alternative zur Transfusion allogener Erythrozyten. Derzeit werden zwei Substanzgruppen im Tierexperiment und in klinischen Studien auf ihre Sicherheit und Wirksamkeit bei schwerer, transfusionsbedürftiger Anämie untersucht. Infusionslösungen auf der Basis von isoliertem menschlichem und tierischem (bovinem) Hämoglobin weisen zusätzlich zu ihrer Fähigkeit des Sauerstofftransports eine vasokonstriktorische Potenz auf, deren Bedeutung für Organperfusion und -funktion nicht vollständig geklärt ist. Dennoch erhielt die Rinderhämoglobinlösung Hemopure^® im April 2001 die Zulassung in Südafrika. Perfluorokarbon- (PFC-)Emulsionen werden rein synthetisch hergestellt und erhöhen die Löslichkeit von Sauerstoff im Plasma. Die obligate Dosislimitierung zur Vermeidung immunsuppressiver Effekte (Funktionseinschränkung von Zellen des retikuloendothelialen Systems, RES, durch Phagozytose von PFC-Emulsionströpfchen) sowie die fehlende Onkotizität verbieten den 1:1-Ersatz von Blutverlusten durch PFC. Als Bestandteil eines multimodalen fremdblutsparenden Konzeptes, insbesondere in Kombination mit normovolämischer Hämodilution und Hyperoxie, kann die niedrig-dosierte Bolusanwendung der PFC-Emulsion Oxygent^® die intraoperative Anämietoleranz steigern. Obwohl mit beiden Substanzgruppen, Hämoglobinlösungen und PFC, die Reduktion perioperativer Fremdbluttransfusionen bereits in einzelnen klinischen Studien nachgewiesen werden konnte, ist ihre Einführung in die breite klinische Praxis derzeit nicht absehbar.

Amberson W, Jennings JJ, Rhode M (1949) Clinical experience with hemoglobin-saline solutions. J Appl Physiol 1:469–489

Barnikol WKR, Pötzschke H (2005) Haemoglobin hyperpolymers, a new type of artificial oxygen carrier — The concept and current state of development. Anasthesiol Intensivmed Notfallmed Schmerzther 40:46–58

Botzlar A, Nolte D, Messmer K (1996) Effects of ultra-purified polymerized bovine hemoglobin on the microcirculation of striated skin muscle in hamster. Eur J Med Res 1:471–478

Bunn HF (1971) Differences in the interaction of 2,3-diphosphoglycerate with certain mammalian hemoglobins. Science 172:1049–1050

Busch ORC, Hop WCJ, Hoynck van Papendrecht MAW, Marquet RL, Jeekel J (1993) Blood transfusion and prognosis in colorectal cancer. N Engl J Med 328:1372–1376

Carmichael FJL, Ali ACY, Campbell JA et al. (2000) A phase I study of oxidized raffinose cross-linked human hemoglobin. Crit Care Med 28:2283–2292

Caswell JE, Strange MB, Rimmer DM, Gibson GF, Cole P, Lefer DJ (2005) A novel hemoglobin-based blood substitute protects against myocardial reperfusion injury. Am J Physiol 288:1796–1801

Chang T, Varma R (1992) Effect of a single replacement of one ringer lactate, hypertonic saline/dextrane, 7 g% albumin, stroma-free hemoglobin, o-raffinose polyhemoglobin or whole blood on the long term survival of unanesthetized rats with lethal hemorrhagic shock after 67% acute blood loss. Biomater Artif Cells Immobil Biotechnol 20:503–510

Cheng DC, Mazer CD, Martineau R et al. (2004) A phase II dose-response study of hemoglobin raffimer (Hemolink) in elective coronary artery bypass surgery. J Thorac Cardiovasc Surg 127:79–87

10.

Cleman M, Jaffee CC, Wohlgelernter D (1986) Prevention of ischemia during percutaneous transluminal coronary angioplasty by transcatheter infusion of oxygenated Fluosol DA 20%. Circulation 3:555–562

11.

Djordjevich L, Miller IF (1980) Synthetic erythrocytes from lipid encapsulated hemoglobin. Exp Hematol 8:584–592

12.

Dobschuetz E von, Hoffmann T, Messmer K (1999) Diaspirin cross-linked hemoglobin effectively restores pancreatic microcirculatory failure in hemorrhagic shock. Anesthesiology 91:1754–1762

13.

Drobin D, Kjellstrom T, Malm E et al. (2004) Hemodynamic response and oxygen transport in pigs resuscitated with maleimide-polyethylene glycol-modified hemoglobin (MP4). J Appl Physiol 96:1843–1853

14.

Eich RF, Li T, Lemon DD, Doherty DH et al. (1996) Mechanism of NO-induced oxidation of myoglobin and hemoglobin. Biochemistry 35:6976–6983

15.

Faithfull NS (1987) Fluorocarbons. Anaesthesia 42:234–242

16.

Faithfull NS (1992) Oxygen delivery from fluorocarbon emulsions — Aspects of convective and diffusive transport. Biomater Artif Cells Immobil Biotechnol 20:797–804

17.

Farmer MC, Johnson SA, Beissinger RL, Gossage JL, Lynn AB, Carter KA (1988) Liposome-encapsulated hemoglobin: a synthetic red cell. Adv Exp Med Biol 238:161–170

18.

Flaim SF (1994) Pharmacokinetics and side effects of perfluorocarbon-based blood substitutes. Artif Cells Blood Substit Immobil Biotechnol 22:1043–1054

19.

Frumento RJ, Mongero L, Naka Y, Bennett-Guerrero E (2002) Preserved gastric tonometry variables in cardiac surgical patients administered intravenous perflubron emulsion. Anesth Analg 94:809–814

20.

Garrioch MA, McClure JH, Wildsmith JAW (1999) Haemodynamic effects of diaspirin crosslinked haemoglobin (DCLHb) given before abdominal aortic aneurysm surgery. Br J Anaesth 83:702–707

21.

Goodnough LT, Shander A, Brecher ME (2003) Transfusion medicine: looking to the future. Lancet 361:161–169

22.

Gould SA, Rosen AL, Sehgal LR et al. (1986) Fluosol-DA as a red cell substitute in acute anaemia. N Engl J Med 314:1653–1656

23.

Gould SA, Moore EE, Hoyt DB et al. (1998) The first randomized trial of human polymerized hemoglobin as a blood substitute in acute trauma and emergent surgery. J Am Coll Surg 187:113–122

24.

Gould SA, Moore EE, Hoyt DB et al. (2002) The life-sustaining capacity of human polymerized hemoglobin when red cells might be unavailable. J Am Coll Surg 195:445–455

25.

Greenburg AG, Kim HW, Hemolink study group (2004) Use of an oxygen therapeutic as an adjunct to intraoperative autologous donation to reduce transfusion requirements in patients undergoing coronary artery bypass graft surgery. J Am Coll Surg 198:373–383

26.

Habler O, Messmer K (2000) Tissue oxygenation and perfusion with blood substitutes. Adv Drug Deliv Rev 40:171–184

27.

Habler O, Kleen M, Messmer K (1997) Clinical potential of intravenously administered perfluorocarbons. Acta Anaesthesiol Scand 41:256–258

28.

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

29.

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

30.

Habler O, Kleen M, Pape A, Meisner F, Kemming G, Messmer K (2000) Diaspirin-crosslinked hemoglobin reduces mortality of severe hemorrhagic shock in pigs with critical coronary stenosis. Crit Care Med 28:1889–1898

31.

Hayes JK, Stanley TH, Lind GH, East K, Smith B, Kessler K (2001) A double-blind study to evaluate the safety of recombinant human hemoglobin in surgical patients during general anesthesia. J Cardiothorac Vasc Anesth 15:593–602

32.

Heiss MM, Mempel W, Jauch KW et al. (1993) Beneficial effect of autologous blood transfusion on infectious complications after colorectal cancer surgery. Lancet 342:1328–1333

33.

Herrmann J, Hutter J, Messmer K (2004) rHb2.0 for injection for resuscitation from hemorrhagic shock. In: Messmer K, Burhop KE, Hutter J (eds) Microcirculatory effects of hemoglobin solutions. Karger, Basel, pp 86–94

34.

Hill SE, Gottschalk LI, Grichnik K (2002) Safety and preliminary efficacy of hemoglobin raffimer for patients undergoing coronary artery bypass surgery. J Cardiothorac Vasc Anesth 16:695–702

35.

Hutter J, Hermann J, Juri G, Messmer K (2004) Moderate hemodilution with rHb2.0 for injection. In: Messmer K, Burhop KE, Hutter J (eds) Microcirculatory effects of hemoglobin solutions. Karger, Basel, pp 65–74

36.

Hutter J, Sinitsina I, Hermann J, Messmer K (2004) Total blood exchange with diaspirin cross-linked hemoglobin is compatible with long-term survival. In: Messmer K, Burhop KE, Hutter J (eds) Microcirculatory effects of hemoglobin solutions. Karger, Basel, pp 39–47

37.

Johnson JL, Moore EE, Gonzalez RJ, Fedel N, Partrick DA, Silliman CC (2003) Alteration of postinjury hyperinflammatory response by means of resuscitation with a red cell substitute. J Trauma 54:133–140

38.

Karger R, Kretschmer V, Wulf H (2004) Risiken der Transfusion von Blutkomponenten: Aktuelle Anhaltszahlen für eine „quantitative“ Risikoaufklärung. Anaesthesiol Intensivmed 45:430–434

39.

Kasper S-M, Walter M, Grüne F, Bischoff A, Erasmi H, Buzello W (1996) Effects of a hemoglobin-based oxygen carrier (HBOC-201) on hemodynamics and oxygen transport in patients undergoing preoperative hemodilution for elective abdominal aortic surgery. Anesth Analg 83:921–927

40.

Keipert PE, Faithfull NS, Roth DJ, Bradley JD, Batra S, Jochelson P, Flaim KE (1996) Supporting tissue oxygenation during acute surgical bleeding using a perfluorochemical-based oxygen carrier. Adv Exp Med Biol 388:603–609

41.

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

42.

Kemming GI, Meisner FG, Meier J, Tillmanns J, Thein E, Eriskat J, Habler OP (2004) Hyperoxic ventilation at the critical hematocrit: effects on myocardial perfusion and function. Acta Anaesthesiol Scand 48:951–959

43.

Kemming GI, Meisner FG, Wojtczyk CJ et al. (2005) Oxygent(TM) as a top load to colloid and hyperoxia is more effective in resuscitation from hemorrhagic shock than colloid and hyperoxia alone. Shock (in press)

44.

Kent KM, Cleman MW, Cowley MJ et al. (1990) Reduction of myocardial ischemia during percutaneous transluminal coronary angioplasty with oxygenated Fluosol. Am J Cardiol 66:279–284

45.

Khopade AJ, Khopade S, Jain NK (2002) Development of hemoglobin aquasomes from spherical hydroxyapatite cores precipitated in the presence of half-generation poly(amidoamine) dendrimer. Int J Pharm 241:145–154

46.

Komatsu T, Yamamoto H, Huang Y, Horinouchi H, Kobayashi K, Tsuchida E (2004) Exchange transfusion with synthetic oxygen-carrying plasma protein „albumin-heme“ into an acute anemia rat model after seventy-percent hemodilution. J Biomed Mater Res 71A:644–651

47.

Lamuraglia GM, O’Hara PJ, Baker WH, Naslund TC, Norris EJ, Li J, Vandermeersch E (2000) The reduction of the allogeneic transfusion requirement in aortic surgery with a hemoglobin-based solution. J Vasc Surg 31:299–308

48.

Lamy ML, Daily EK, Brichant J-F et al. (2000) Randomized trial of diaspirin cross-linked hemoglobin solution as an alternative to blood transfusion after cardiac surgery. Anesthesiology 92:646–656

49.

Lanzkron S, Moliterno AR, Norris EJ, Gould SA, Segal J, Nuermberger EL, Ness PM (2002) Polymerized human Hb use in acute chest syndrome: a case report. Transfusion 42:1422–1427

50.

Lee R, Atsumi N, Jacobs EE, Austen WG, Vlahakes GJ (1989) Ultrapure, stroma-free, polymerized bovine hemoglobin solution: evaluation of renal toxicity. J Surg Res 47:407–411

51.

Levy JH, Goodnough LT, Greilich PE et al. (2002) Polymerized bovine hemoglobin solution as a replacement for allogeneic red blood cell transfusion after cardiac surgery: results of a randomized, double-blind trial. J Thorac Cardiovasc Surg 124:35–42

52.

Lieberthal W, Fuhro R, Freedman JE, Toolan G, Loscalzo J, Valeri CR (1999) O-raffinose cross-linking markedly reduces systemic and renal vasoconstrictor effects on unmodified human hemoglobin. J Pharmacol Exp Ther 288:1278–1287

53.

Loeb AL, McIntosh LJ, Raj NR, Longnecker DE (1998) Resuscitation after hemorrhage using recombinant human hemoglobin (rHb1.1) in rats: effects on nitric oxide and prostanoid systems. Crit Care Med 26:1071–1080

54.

Maevsky E, Ivanitsky G, Bogdanova L et al. (2005) Clinical results of Perftoran application: present and future. Artif Cells Blood Substit Immobil Biotechnol 33:37–46

55.

Malhotra AK, Kelly ME, Miller PR, Hartman JC, Fabian TC, Proctor KG (2003) Resuscitation with a novel hemoglobin-based oxygen carrier in a swine model of uncontrolled perioperative hemorrhage. J Trauma 54:915–924

56.

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

57.

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

58.

Mitsuno T, Ohyanagi H, Naito R (1982) Clinical studies of a perfluorochemical whole blood substitute (Fluosol-DA). Ann Surg 195:60–69

59.

Mitsuno T, Ohyanagi H, Yokoyama K, Suyama T (1988) Recent studies on perfluorochemical (PFC) emulsion as an oxygen carrier in Japan. Biomater Artif Cells Artif Organs 16:365–373

60.

Mullon J, Giacoppe G, Clagett C, McCune D, Dillard T (2000) Transfusions of polymerized bovine hemoglobin in a patient with severe autoimmune hemolytic anemia. N Engl J Med 342:1638–1643

61.

Nagababu E, Ramasamy S, Rifkind JM, Jia Y, Alayash AI (2002) Site specific cross-linking of human and bovine hemoglobins differentially alters oxygen binding and redox side reaction producing rhombic heme and heme degradation. Biochemistry 41:7407–7415

62.

Nolte D, Steinhauser P, Berger S, Härtl R, Messmer K (1997) Effects of diaspirin-cross-linked hemoglobin (DCLHb) on local tissue oxygen tension in striated skin muscle: an efficacy study in the hamster. J Lab Clin Med 130:328–338

63.

Oda T, Nakajima Y, Kimura T, Ogata Y, Fujise Y (2004) Hemodilution with liposome-encapsulated low-oxygen-affinity hemoglobin facilitates rapid recovery from ischemic acidosis after cerebral ischemia in rats. J Artif Organs 7:101–106

64.

Ohyanagi H, Toshima H, Sekita M et al. (1979) Clinical studies of perfluorochemical whole-blood substitutes: safety of Fluosol-DA (20%) in normal human volunteers. Clin Ther 2:306–312

65.

Perutz MF (1969) Structure and function of haemoglobin. Harvey Lect 63:213–261

66.

Pickelmann S, Nolte D, Leiderer R, Schütze E, Messmer K (1998) Attenuation of postischemic reperfusion injury in striated skin muscle by diaspirin-cross-linked Hb. Am J Physiol 275:H361–368

67.

Rao SV, Jollis JG, Harrington RA et al. (2004) Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes. JAMA 292:1555–1562

68.

Riess JG (1991) Fluorocarbon-based in vivo oxygen transport and delivery systems. Vox Sang 61:225–239

69.

Sakai H, Hara H, Yuasa M, Tsai A, Takeoka S, Tsuchida E, Intaglietta M (2000) Molecular dimensions of Hb-based O₂ carriers determine constriction of resistance arteries and hypertension. Am J Physiol 279:H908–915

70.

Sargent JW, Sefel RJ (1970) Properties of perfluorinated liquids. Fed Proc 19:1699–1703

71.

Savitzky JP, Doczi J, Black J, Arnold JD (1978) A clinical safety trial of stroma-free hemoglobin. Clin Pharmacol Ther 73–80

72.

Schubert A, Przybelski RJ, Eidt JF, Lasky LC, Marks KE, Karafa M, Novick AC, O’Hara JF, Saunders ME, Blue JW, Tetzlaff JE, Mascha E, PARRT Study Group (2003) Diaspirin-crosslinked hemoglobin reduces blood transfusion in noncardiac surgery: a multicenter, randomized, controlled double-blinded trial. Anesth Analg 97:323–332

73.

Schultz SC, Hamilton IN, Malcolm DS (1993) Use of base deficit to compare resuscitation with lactated ringer’s solution, haemaccel, whole blood and diaspirin cross-linked hemoglobin following hemorrhage in rats. J Trauma 35:619–626

74.

Seghal LR, Gould SA, Rosen AL, Seghal HL, Moss GS (1984) Polymerized pyridoxalated hemoglobin: a red cell substitute with normal oxygen capacity. Surgery 95:433–438

75.

Sellards AW, Minot GR (1916) Injection of hemoglobin in man and its relation to blood destruction with special reference to anemias. J Med Res 34:469

76.

Siegel JH, Fabian M, Smith JA, Costantino D (1997) Use of recombinant hemoglobin solution in reversing hemorrhagic hypovolemic oxygen debt shock. J Trauma 42:199–212

77.

Sielenkämper AW, Chin-Yee IH, Martin CM, Sibbald WJ (1997) Diaspirin crosslinked hemoglobin improves systemic oxygen uptake in oxygen supply-dependent septic rats. Am J Respir Crit Care Med 156:1066–1072

78.

Slanetz PJ, Lee R, Page R, Jacobs EE, LaRaia PJ, Vlahakes GJ (1994) Hemoglobin blood substitutes in extended preoperative autologous blood donation: an experimental study. Surgery 115:246–254

79.

Sloan EP, Koenigsberg M, Gens D, Cipolle M, Runge J, Mallory MN, Rodman G (1999) Diaspirin cross-linked hemoglobin (DCLHb) in the treatment of severe traumatic hemorrhagic shock. JAMA 282:1857–1864

80.

Spahn DR, Bremt R van, Theilmeier G, Reibold JP, Welte M, Dunger-Baldauf C, Heinzerling H, Birck M, Keipert P, Messmer K, the European Perflubron Emulsion Study Group (1999) Perflubron emulsion delays blood transfusions in orthopedic surgery. Anesthesiology 91:1195–1208

81.

Spahn DR, Waschke KF, Standl T, Motsch J, Huynegem L van, Welte M, Gombotz H, Coriat P, the European Perflubron Emulsion in Non-cardiac Surgery Study Group (2002) Use of perflubron emulsion to decrease allogeneic blood transfusion in high-blood-loss non-cardiac surgery. Anesthesiology 97:1338–1349

82.

Spence RK, McCoy S, Costabile J et al. (1990) Fluosol DA-20 in the treatment of severe anemia: randomized, controlled study of 46 patients. Crit Care Med 18:1227–1230

83.

Sprung J, Mackenzie CF, Barnas GB et al. (1995) Oxygen transport and cardiovascular effects of resuscitation from severe hemorrhagic shock using hemoglobin solutions. Crit Care Med 23:1540–1553

84.

Sprung J, Kindscher JD, Wahr JA, Levy JH, Monk TG, Moritz MW, O’Hara PJ (2002) The use of bovine hemoglobin glutamer-250 (Hemopure^R) in surgical patients: results of a multicenter, randomized, single-blinded trial. Anesth Analg 94:799–808

85.

Standl T, Horn P, Wilhelm S et al. (1996) Bovine hemoglobin is more potent than autologous red blood cells in restoring muscular tissue oxygenation after profound isovolemic haemodilution in dogs. Can J Anesth 43:714–723

86.

Standl T, Wilhelm S, Horn EP, Burmeister M, Gundlach M, Schulte am Esch J (1997) Präoperative Hämodilution mit bovinem Hämoglobin. Anaesthesist 46:763–770

87.

Standl TG, Reeker W, Redmann G, Kochs E, Werner C, Schulte am Esch J (1997) Haemodynamic changes and skeletal muscle oxygen tension during complete blood exchange with ultrapurified polymerized bovine hemoglobin. Intensive Care Med 23:865–872

88.

Standl T, Burmeister MA, Horn EP, Wilhelm S, Knoefel WT, Schulte am Esch J (1998) Bovine haemoglobin-based oxygen carrier for patients undergoing haemodilution before liver resection. Br J Anaesth 80:189–194

89.

Starck G von (1898) Über Hämoglobin-Injektionen. Munch Med Wochenschr 14:69–72

90.

Stern SA, Dronen SC, McGoron AJ et al. (1995) Effect of supplemental perfluorocarbon administration on hypotensive resuscitation of severe uncontrolled hemorrhage. Am J Emerg Med 13:269–275

91.

Strate T, Mann O, Kleinhans H et al. (2003) Systemic intravenous infusion of bovine hemoglobin significantly reduces microcirculatory dysfunction in experimentally induced pancreatitis in the rat. Ann Surg 238:765–771

92.

Toy P, Gajic O (2004) Transfusion-related acute lung injury. Anesth Analg 99:1623–1624

93.

Tremper KK (2002) Perfluorochemical „red blood cell substitutes“ — The continued search for an indication. Anesthesiology 97:1333–1334

94.

Tsai AG, Cabrales P, Winslow RM, Intaglietta M (2003) Microvascular oxygen distribution in awake hamster window chamber model during hyperoxia. Am J Physiol 285:1537–1545

95.

Vamvakas EC, Taswell HF (1994) Epidemiology of blood transfusion. Transfusion 34:464–470

96.

Vandegriff KD, Malavilli A, Wooldridge J, Lohman J, Winslow RM (2004) MP4, a new nonvasoactive PEG-Hb conjugate. Transfusion 43:509–516

97.

Weber EWC, Slappendel R, Prins MH, Schaaf DB van der, Durieux ME, Stümper D (2005) Perioperative blood transfusions and delayed wound healing after hip replacement surgery: effects on duration of hospitalization. Anesth Analg 100:1416–1421

98.

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

99.

Wettstein R, Tsai AG, Erni D, Winslow RM, Intaglietta M (2003) Resuscitation with polyethylene glycol-modified human hemoglobin improves microcirculatory blood flow and tissue oxygenation after hemorrhagic shock in awake hamsters. Crit Care Med 31:1824–1830

Titel: Künstliche Sauerstoffträger als Alternative zur Bluttransfusion
verfasst von: Univ.-Prof. Dr. O. Habler
A. Pape
J. Meier
B. Zwißler
Publikationsdatum: 01.08.2005
Verlag: Springer-Verlag
Erschienen in: Die Anaesthesiologie / Ausgabe 8/2005
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI: https://doi.org/10.1007/s00101-005-0893-3

Neu im Fachgebiet AINS

Mit dem Seitenschneider gegen das Reißverschluss-Malheur

03.06.2024 Urologische Notfallmedizin Nachrichten

Wer ihn je erlebt hat, wird ihn nicht vergessen: den Schmerz, den die beim Öffnen oder Schließen des Reißverschlusses am Hosenschlitz eingeklemmte Haut am Penis oder Skrotum verursacht. Eine neue Methode für rasche Abhilfe hat ein US-Team getestet.

Blutdrucksenkung schon im Rettungswagen bei akutem Schlaganfall?

31.05.2024 Apoplex Nachrichten

Der optimale Ansatz für die Blutdruckkontrolle bei Patientinnen und Patienten mit akutem Schlaganfall ist noch nicht gefunden. Ob sich eine frühzeitige Therapie der Hypertonie noch während des Transports in die Klinik lohnt, hat jetzt eine Studie aus China untersucht.

Nicht Creutzfeldt Jakob, sondern Abführtee-Vergiftung

29.05.2024 Hyponatriämie Nachrichten

Eine ältere Frau trinkt regelmäßig Sennesblättertee gegen ihre Verstopfung. Der scheint plötzlich gut zu wirken. Auf Durchfall und Erbrechen folgt allerdings eine Hyponatriämie. Nach deren Korrektur kommt es plötzlich zu progredienten Kognitions- und Verhaltensstörungen.

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Künstliche Sauerstoffträger als Alternative zur Bluttransfusion

Zusammenfassung

Neu im Fachgebiet AINS

Mit dem Seitenschneider gegen das Reißverschluss-Malheur

Blutdrucksenkung schon im Rettungswagen bei akutem Schlaganfall?

Ähnliche Überlebensraten nach Reanimation während des Transports bzw. vor Ort

Nicht Creutzfeldt Jakob, sondern Abführtee-Vergiftung

Update AINS

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2005

Der Würzburger Schockraumalgorithmus

Hochdosierte Fibrinogengabe zur Akuttherapie von Gerinnungsstörungen bei perioperativer Massivtransfusion

Die österreichische Facharztprüfung für Anästhesiologie und Intensivmedizin

Die Grenzen der Einfühlung

Dynamische Entscheidungsfindung in der Notfallmedizin

Bildgebende Diagnostik des Thorax bei Intensivpatienten

Neu im Fachgebiet AINS

Mit dem Seitenschneider gegen das Reißverschluss-Malheur

Blutdrucksenkung schon im Rettungswagen bei akutem Schlaganfall?

Ähnliche Überlebensraten nach Reanimation während des Transports bzw. vor Ort

Nicht Creutzfeldt Jakob, sondern Abführtee-Vergiftung

Update AINS