Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Despite of some discussion, there is general acceptance of the brain death criterion. As for Germany, there is a quasi legal regulation (TPG §16): two physicians with a longstanding experience in the management of patients with severe brain lesions are personally responsive for the diagnostic procedure lege artis. ⋯ Nevertheless, discussions on brain death should not be instrumentalized by circumstances of organ explantation. Brain death should be part of a good educational background, to anticipate reflections free from the emotional binding of an acute incident.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2012
[Anaesthesia in patients after transplantation].
More than 17000 patients currently live in Germany who have had organ transplants. The implications of this for the anaesthetists are that they are very likely to be confronted by such a patient at some point during their active career. Besides the preoperative assessment which includes that of the function of the transplanted organ, appropriate immunosuppression poses a particular challenge. ⋯ Strictly aseptic measures are mandatory as well as detailed evaluation of the risk-benefit balance of all invasive procedures. There are no significant differences between the anaesthetic approaches and agents in transplant and non-transplant patients. However, in the latter group, homeostasis of all organ systems should be more focused on.
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The demand for donor organs continues to exceed the number of organs available for transplantation. The assistance to the family members of a potential donor in forefront of transplantation is as much important as to maintain donor organ function. Caring for a brain dead potential organ donor is therefore major challenge for nurses and physicians. ⋯ The management of potential organ donors is similar to the management of patients with severe sepsis. The main goal of that treatment is to achieve hemodynamic stability as well as the normalization of endocrine and metabolic disturbances. Donor optimization leads to increased organ procurement and contributes to improved organ function in the recipient.