Anästhesie in der Orthopädie / Unfallchirurgie – Narkoseführung und Kreislauf-management in sitzender Position

Zusammenfassung

Jährlich werden tausende Patienten in sitzender Position operiert. Meist handelt es sich um die Beach-Chair-Lagerung (BCL). Durch Fallberichte über deletäre neurologische Verläufe nach Operationen in BCL und Allgemeinanästhesie wird die Sicherheit der BCL unter Allgemeinanästhesie kontrovers diskutiert. Diese Übersichtsarbeit stellt die lagerungsbedingten Komplikationsmöglichkeiten dar und gibt Hilfestellung für die tägliche Praxis.

Abstract

Every year thousands of patients are operated in the sitting position. The most common position is the beach chair position. Due to case reports with deleterious neurologic outcome, the safety of the beach chair position in combination with general anesthesia is discussed controversially. In this review article the possible complications according to the beach chair position are explained and practical advice is given for the daily anesthetic routine.

Kernaussagen

• Fatale neurologische Komplikationen nach Operationen in sitzenden Positionen sind sehr selten.

• Eine Regionalanästhesie sollte wenn möglich bevorzugt werden.

• Die Indikation für eine kontinuierliche Blutdruckmessung sollte bei entsprechenden Komorbiditäten großzügig gestellt werden.

• Eine hypotensive Phase sollte schnellstmöglich behandelt werden.

• Der Einsatz der NIRS kann frühzeitig auf zerebrale Minderperfusionen hinweisen.

• Bei der nicht invasiven Messung des Blutdrucks muss die Manschette am Oberarm angelegt und die Werte müssen um das hydrostatische Gefälle zum Kopf korrigiert werden.

• Bei invasiv gemessenem Blutdruck muss der Druckaufnehmer auf Gehörgangshöhe angebracht werden.

• Eine vom Operateur geforderte kontrollierte Hypotension darf nicht unreflektiert umgesetzt werden.

• Evidenzbasierte absolute Grenzwerte für eine zu tolerierende Hypotonie können nicht allgemeingültig festgelegt werden. Kritisch scheinen jedoch ein MAD < 60 mmHg oder ein systolischer Blutdruck < 90 mmHg.

• Eine Hyperventilation ist zu vermeiden.

Schlüsselwörter:

Beach-Chair-Lagerung - sitzende Lagerung - Hypotension - Allgemeinanästhesie - Regionalanästhesie

Key words:

beach chair position - sitting position - hypotension - general anesthesia - regional anesthesia

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