Venous stasis on the operating table

Lewis, Charles E.; Mueller, Charles; Edwards, W. Sterling

doi:10.1097/00006534-197307000-00041

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“…2) und -abhängigen Thrombose-Risiken ausgesetzt, wie andere operative Patienten (96); intraoperativ oder am Op-Tag sollen bis zu 50% der Thrombosen entstehen, wenn die Op länger als 4 Stunden dauert (37,76,93,136). Die Konsensus-Konferenz hat neurochirurgische Patienten deswegen als .Hochrisikogruppe" klassifiziert (29,114,125,134).…”

Section: Besondere Risiken In Der Neurochirurgieunclassified

“…Das gilt für die Beinhochlagerung(19), für elastische Binden und auch für die mancherorts "historisch" genannten Kompressionsstrümpfe (l08). Insbesondere dann, wenn diese falsch -nach Art eines Tourniquets oberhalb des Knies-angelegt sind, können sie sogar nachteilig wirken(19,76,106); über 2 Fälle arterieller Thrombosen wurde in diesem Zusammenhang berichtet(50); das D. Moskopp, S. Popou-Cenic…”

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Zum Stand der peri-operativen Thrombo-Embolie-Prophylaxe in der Neurochirurgie

Moskopp¹,

Popov-Cenić²

1990

Minim Invasive Neurosurg

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In neurosurgery, none of the drugs used in other specialties as prophylaxis of thrombo-embolism have found general acceptance. Certain centers reject any drug prophylaxis of thrombo-embolism. Others treat many or--with the exception of subarachnoid hemorrhage--almost all patients according to the Kakkarscheme. Many aim for an individual examination of the risk of early mobilization and, if necessary, combine mechanical and medicinal methods (Tab. 3). No center has published any systematic studies of substantial patient populations. It is not possible to draw any medico-legal conclusions from the neurosurgical literature available. The multitude of diagnostic and therapeutic regimes, sometimes accompanied by contradictory publications, means that even non-neurosurgeons regard neither the diagnosis nor the treatment of thrombo-embolisms as ideal. Even under low-dose heparinization, deep venous thromboses can occur, and it is in principle difficult to refute the contention that this fact changes nothing whatsoever for high-risk patients as far as the incidence of pulmonary embolism ot the occurrence of significant thrombo-embolic events is concerned. Cost calculations have proved that general thrombo-embolism prophylaxis is more expensive than individual thrombosis treatment as necessary (although there are statements to the contrary). It can, however, be stated that additional costs with the aim of improving or maintaining the quality of life would be economically justifiable if a preventive effect were proved. For modern neurosurgery, however, this neither holds true generally nor for a specific subgroup. The state of research would seem to suggest that a prospective, controlled study of neurosurgical patients, primarily in a relatively low-risk group, is necessary, advisable, and justifiable.

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Section: Besondere Risiken In Der Neurochirurgieunclassified

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