Patient Information

With the use of efficient medication and anesthetic agents, patients are placed into a deep, sleep-like state, allowing even major surgeries to be performed without pain. Throughout the procedure, vital signs such as heart activity (ECG), blood pressure, and blood oxygen levels (oxygen saturation) are continuously monitored.

In this deep sleep state, breathing must be supported or fully managed with the help of a ventilator. This requires placing a breathing tube (endotracheal tube) into the windpipe, which is done only after the patient is fully asleep. For less invasive procedures, breathing support may be provided using a mask placed on the face or throat (laryngeal mask) instead of a breathing tube.

At the conclusion of the surgery, the anesthetic agents are stopped, and as the patient gradually awakens, the breathing tube or laryngeal mask is removed. Patients are then transferred to the recovery room for close monitoring. Vital organ functions are observed, and additional pain medication is provided if needed. Patients are only transferred back to the general ward of the surgical department once their circulation is stable, breathing is normal, and pain is well-managed.

For more extensive surgeries or in cases of significant pre-existing health conditions, patients may need to be transferred directly to an intensive care unit (ICU) instead of the recovery room. This transfer may occur while the patient is still deeply asleep or after they have awakened from anesthesia.

Regional anesthesia can be divided into two main types. The first involves techniques applied near the spinal cord, such as epidural anesthesia or spinal anesthesia. The second includes plexus anesthesia and peripheral nerve blocks, which target specific nerve groups outside the spinal cord.

For all types of regional anesthesia, normal blood clotting is essential, and the injection site must be free from inflammation to ensure safety and effectiveness.

Epidural Anesthesia

In this technique, a local anesthetic is administered either as a single injection (single-shot epidural) or through a thin tube (epidural catheter) after numbing the injection site on your back with an additional local anesthetic. The injection is placed between the vertebrae, just outside the thick membrane that surrounds the spinal cord.

The level of injection (thoracic or lumbar spine) and the dose of anesthetic determine the extent and duration of pain relief. Epidural anesthesia is commonly used for pain management during childbirth. It can also be combined with general anesthesia to reduce the need for strong painkillers during and after major surgeries, such as esophageal surgery for esophageal cancer.

Spinal Anesthesia

Unlike epidural anesthesia, spinal anesthesia involves injecting a local anesthetic directly around the nerve roots of the spinal cord in the lumbar region using a thin needle. Depending on the type and dose of anesthetic, this technique provides pain relief and temporary paralysis lasting approximately 2 to 6 hours, typically from the navel down to the toes.

Spinal anesthesia is typically used for various orthopedic surgeries, such as hip or knee replacements, as well as for procedures like cesarean sections.

Plexus Anesthesia

This technique involves injecting a local anesthetic into the area of a nerve plexus—a region where nerve fibers converge after leaving the spinal cord. To ensure the anesthetic is safely and precisely delivered near the targeted nerve, the procedure is typically performed under ultrasound guidance.

Plexus anesthesia administered near the shoulder or armpit enables most surgeries to be performed on areas from the shoulder down to the hand.

Peripheral Nerve Block

This method involves injecting a local anesthetic near individual nerves in the arm or leg to block pain in a specific area. Similar to plexus anesthesia, the injection is typically performed under ultrasound guidance to ensure precise placement and optimal effectiveness.

Patient Blood Management (PBM) is a cornerstone of our clinical practice, focusing on the responsible use of each patient’s own blood. This approach prioritizes patient safety while ensuring effective care. In collaboration with our surgical partners and the University Department of Blood Group Serology and Transfusion Medicine, we implement a range of strategies to enhance the body’s natural blood production, reduce blood loss, and optimize the body’s ability to tolerate anemia.

By minimizing the need for donor blood transfusions, we not only support better outcomes for our patients but also help preserve vital blood reserves, which are often essential for saving lives.

Key Areas of Patient Blood Management

• Preoperative Anemia Diagnosis and Treatment: Iron can be administered intravenously to treat iron deficiency, that may be the cause of anemia.
• Point-of-Care Coagulation Management: Optimal regulation of blood clotting helps to prevent and treat bleeding.
• Reduced Blood Volume for Blood Culture Diagnostics and Blood Tests: Modern lab methods enable diagnostics using small blood quantities.
• Cell-Saver: For major surgeries, during surgery blood can be collected, processed, and transfused back to the patient as their own blood.
• 'Just in Time' Transfusion: Continuous perioperative monitoring of vital functions and laboratory parameters allows precise determination of the transfusion timing and avoids “over-transfusion”-
• Blood-Saving Surgical Techniques: Our surgical partners use specialized tissue-preserving techniques to reduce blood loss.
• Intensive Care Monitoring: Close monitoring of vital parameters and functions after major surgeries can reduce the need for transfusions.

Further Reading

• Braunschmid T et al. Prevalence and long-term implications of preoperative anemia in patients undergoing elective general surgery: a retrospective cohort study at a university hospital. Int J Surg. 2024. Link
• Meybohm P et al. German Patient Blood Management Network: effectiveness and safety analysis in 1.2 million patients. Br J Anaesth 2023. Link
• Spahn DR et al. Patient Blood Management: Effectiveness and Future Potential. Anesthesiology 2020. Link
• Goodnough TL et al. Management of anemia in patients with congestive heart failure. Am J Hematol 2017. Link
• Baron DM et al. Evaluation of clinical practice in perioperative patient blood management. Br J Anaesth 2016. Link
• Munoz M et al. 'Fit to fly': overcoming barriers to preoperative haemoglobin optimization in surgical patients. Br J Anaesth 2015. Link
• Baron DM et al. Preoperative anaemia is associated with poor clinical outcome in non-cardiac surgery patients. Br J Anaesth 2014. Link

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