ABSTRACT
Microsurgery is a very relevant component of reconstructive surgery. In this context anticoagulation plays an increasing role. At the moment there are no unanimously accepted prospective studies or generally accepted regimes available that could serve as evidence-based guidelines for the prevention of thrombosis in microsurgery. With regard to this problem the aim of a series of workshops during the annual meetings of the German-speaking group for microsurgery in 2009 and 2010 was to establish a first possible consensus. This article reflects the main aspects of the ongoing development of a generally acceptable guideline for anticoagulation in microsurgery as interim report of these consensus workshops. Basically there are 3 main agents in thromboprophylaxis available: antiplatelet drugs, dextran and heparin. In the course of the workshops no general use of aspirin or dextran for anticoagulation in microsurgery was recommended. The use of heparin as anticoagulation agent is advisable for different indications. Low molecular heparins (LMH) have certain advantages in comparison to unfractionated heparins (UFH) and are therefore preferred by most participants. Indications for UFH are still complex microsurgical revisions, renal failure and some specific constellations in patients undergoing reconstruction of the lower extremity, where the continuous administration of heparin is recommended. At the moment of clamp release a single-shot of UFH is still given by many microsurgeons, despite a lack of scientific evidence. Future prospective clinical trials and the establishment of a generally accepted evidence-based guideline regarding anticoagulation treatment in microsurgery are deemed necessary.
Subject(s)
Anticoagulants/administration & dosage , Education , Microsurgery/standards , Microvessels/surgery , Perioperative Care/standards , Peripheral Nerves/surgery , Evidence-Based Medicine , Germany , Humans , Partial Thromboplastin Time , Postoperative Complications/blood , Postoperative Complications/prevention & control , Thrombosis/blood , Thrombosis/prevention & controlABSTRACT
BACKGROUND AND OBJECTIVE: In addition to basic research and development of new therapeutic strategies, the education of health care professionals who manage sepsis patients is an important step to decrease the high mortality of severe sepsis. Patient simulators are increasingly used for teaching in anaesthesia. A training program in sepsis management was developed, using a full-scale anaesthesia simulator including the setting of a modern intensive care unit, and its results were evaluated by means of a questionnaire. METHODS: The simulator is controlled from a separate room using a controlling computer provided with physiological models and pharmacokinetic as well as pharmacodynamic patterns of substances commonly used in anaesthesia and intensive care. An important element of the training program is the subsequent debriefing with different modules, according to the individual deficits and needs of the participants detected during simulation. RESULTS: From September 2002 to July 2004 82 physicians participated in the training program. 4 weeks after the training 52 % of the participants stated that they had changed their treatment behaviour due to the training content. They assessed the interactive simulator workshop semiquantitatively on a scale from 1 ("absolutely correct") to 7 ("not correct at all") as follows: Sepsis simulation training (SST) improves identification (mean+/-SD) (2.3 +/- 1.3) and treatment (2.5 +/- 1.2) of patients with severe sepsis, and SST including true-life scenarios is more appropriate than traditional lectures (1.5 +/- 0.7). CONCLUSION: The presented SST could be an effective way to train intensive care specialists in severe sepsis management.
