[Anaesthesia problems in massive transfusion (author's transl)]

It is essential for adequate anaesthesia during massive transfusion to avoid further shift of the oxygen dissociation curve to the left by hyperventilating the patient, by not rewarming the cold blood and by an overenthusiastic correction of an eventually arising metabolic acidosis. The occurrence of coagulation disorders during massive transfusion has been overestimated in the past and is a poor basis for "blind" substitution. The additional use of blood microfilters and caustious attitude towards the use of crystalloid solutions e.g. Ringer lactate, are indispensable measures for counteracting impending pulmonary insufficiency. The avoidance of surfactant irritating inhalation anesthetics such as halothane or methoxyflurane seems advisable. In this context the use of adequate PEEP plays an important role. Circulatory stability is guaranteed by using ketamine or fentanyl for general anaesthesia and analgesia, and by the use of pancuronium for relaxation.