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Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54(04): 268-281
DOI: 10.1055/a-0636-2759
Topthema
Georg Thieme Verlag KG Stuttgart · New York

Ultraschallgesteuerte Regionalanästhesie bei Adipositas

Ultrasound-Guided Regional Anaesthesia in Obesity
Paul Kessler
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Publication History

Publication Date:
12 April 2019 (online)

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Zusammenfassung

Adipositas ist mit einer Reihe anästhesierelevanter Risiken verbunden. Regionalanästhesiologische Verfahren bieten viele Vorteile, stellen jedoch auch eine Herausforderung dar. Der Einsatz der Ultraschalltechnik mit der Möglichkeit, die Zielstrukturen zu visualisieren, kann hier hilfreich sein. Allerdings sind viel Erfahrung und ausreichendes Training Voraussetzung, da die Ultraschalltechnologie bei Adipositas physikalisch limitiert ist.

Abstract

Obesity is associated with a number of anaesthesia-relevant risks. Regional anaesthesia procedures offer a number of advantages, but they also pose an anaesthetic challenge. For example, the identification of superficial landmarks according to the degree of obesity is difficult to impossible, which reduces the success rate compared to normal weight patients. The use of ultrasound (US) technology with the ability to visualize the target structures may be helpful in performing neuraxial and peripheral blockades. However, a lot of experience and training is required because the ultrasound imaging of very low-lying nerves in obese patients is limited due to the physical limitations of US technology.

Kernaussagen

  • Der Anteil adipöser Patienten in der Bevölkerung nimmt stetig zu.

  • Mit einer Regionalanästhesie lassen sich viele mit einer Allgemeinanästhesie verbundene Risiken minimieren oder umgehen.

  • Zunehmende Adipositas erschwert die Durchführung einer neuroaxialen und vieler peripherer Regionalanästhesien und erhöht somit die Versagerrate.

  • Im Vergleich zur Landmarkentechnik bietet die US-gesteuerte Regionalanästhesie viele Vorteile, insbesondere bei adipösen Patienten.

  • Die neuroaxiale Sonografie wird dabei als präprozedurales Untersuchungsinstrument zur Punktionsplanung eingesetzt, um anatomisch relevante Strukturen der Wirbelsäule zu identifizieren.

  • US-assistierte neuroaxiale Blocken zählen zu den fortgeschrittenen sonografischen Verfahren und erfordern ausreichend Übung und Erfahrung.

  • Eine verwertbare Darstellung sehr tief liegender Zielstrukturen und interner Landmarken (> 10 cm) im US-Bild ist aufgrund der Grenzen der US-Technologie schwierig.

Schlüsselwörter

Adipositas - Regionalanästhesie - Ultraschall - Landmarken

Key words

obesity - regional anaesthesia - ultrasound - landmarks
 

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