Begleiterkrankungen und perioperatives Management bei adipösen Erwachsenen

Zusammenfassung

Die Adipositas ist eine globale Epidemie, von der in Deutschland ca. 20 % der Einwohner betroffen sind. Zukünftig werden Anästhesisten daher häufiger adipöse und extrem adipöse Patienten betreuen müssen. Voraussetzung dafür ist die räumliche und apparative Ausrichtung der Klinik auf die Behandlung dieser Patientengruppe. Wichtige Begleiterkrankungen wie Diabetes mellitus, Hypertonus, koronare Herzkrankheit und das Schlaf–Apnoe–Syndrom erhöhen das Risiko adipöser Patienten signifikant. Notwendig sind eine sorgfältige, präoperative Abklärung relevanter Begleiterkrankungen, eine auf die Besonderheiten der Pathophysiologie abgestimmte Narkoseeinleitung und –beatmung und die Kenntnis der pharmakokinetischen Kennzahlen von Anästhetika, um eine optimale Behandlung adipöser Patienten gewährleisten zu können.

Abstract

Obesity is a global epidemic, and approximately 20 % of the German population are obese. Therefore anaesthesiologists will be increasingly involved in the care of obese and morbidly obese patients in the near future. As a prerequisite, the hospital must focus on this patient population with respect to facilities and the availability of tailored medical equipment and supplies. Comorbidities such as diabetes, hypertension, coronary heart disease and sleep apnea considerably increase the risk of obese patients. A thorough preoperative evaluation of comorbidities, an anaesthesia induction and intraoperative ventilation tailored to the pathophysiological sequelae of obesity and a sound knowledge of pharmokocinetics are necessary to ensure optimal care for obese patients.

Schlüsselwörter:

Allgemeinanästhesie - Schlaf–Apnoe–Syndrom - Adipositas - perioperatives Management

Keywords:

Obesity - obstructive sleep apnea - general anaesthesia - perioperative management

Kernaussagen

• Die Zahl übergewichtiger und adipöser Patienten nimmt zu. Damit steigt auch der Anteil dieser Patientenpopulation bei operativen Eingriffen.

• Adipositas ist mit Hypertonus, Fettstoffwechselstörungen, Diabetes mellitus und kardiovaskulären Erkrankungen assoziiert. Die meisten Patienten haben außerdem ein Schlaf–Apnoe–Syndrom.

• Für die Versorgung adipöser Patienten müssen räumlich–apparative Voraussetzungen geschaffen werden, und es muss ein erfahrenes Team bereitstehen.

• Anästhesierelevante Besonderheiten sind Atemwegsprobleme, erschwertes intraoperatives Monitoring und perioperative respiratorische Komplikationen.

• Regionalanästhesiologische Verfahren sollten, wenn möglich, bevorzugt werden.

• Bei Durchführung einer Allgemeinanästhesie bieten moderne Inhalationsanästhetika und Remifentanil Vorteile.

• Die Präoxygenierung ist besonders wichtig. Hierfür ist die umgekehrte Trendelenburg–Lagerung geeignet. Eine CPAP–Atmung vor Einleitung ist empfehlenswert.

• Die postoperative Schmerztherapie sollte regionalanästhesiologische Verfahren und NSAID beinhalten.

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