[Coagulation disorders in the context of cardiac surgery - Clinical basics and mechanism based therapy]. / Herz- und thorakale Gefäßchirurgie - Gerinnungsstörungen: klinische Grundlagen und mechanismenbasierte Therapie.

Intra- and postoperative bleeding disorders are common in cardiac surgery. The etiology of perioperative coagulopathy frequently becomes apparent as a combination of several acquired and inherited disorders. Differential diagnosis of microvascular bleeding include altered homeostasis (e.g. anemia, hypothermia, acidosis, hypocalcemia), impaired primary hemostasis, antithrombotic medication, dilutive and consumptive coagulopathy, fibrinolysis and the absence or deficiency of coagulation factors. Timely detection of underlying pathology and subsequent rigorous treatment has the potential to minimize perioperative transfusion requirements, prevent resternotomy and improve patient outcome remarkably. Point-of-care-systems can provide fast bed-sided analysis, which contribute to early diagnosis and intervention. Individual and regularly revised algorithms, adapted to the individualized institutional infrastructure, may facilitate resource-saving treatment of perioperative coagulopathy.

[Vascular cannulation and hemodynamic monitoring for cardiac and thoracic vascular surgery - a review]. / Herz- und thorakale Gefäßchirurgie - Gefäßkanülierung bei HLM-Einsatz und hämodynamisches Monitoring.

Cardiac surgery requires cardiopulmonary bypass (CPB) with extracorporeal circulation (ECC) for intracardiac procedures. The surgical strategy determines access for monitoring and insertion sites with high-flow cannulas. The perioperative care of cardiac surgical patients requires adequate hemodynamic monitoring for reasonable catecholamine therapy and fluid management. Therefore, the knowledge of the vascular anatomy is essential to provide professional care to patients undergoing ECC during thoracic vascular and cardiac surgery. This article is a review of hemodynamic monitoring and access for ECC in patients for adult cardiac surgery for anaesthesiologists and intensivists.