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Anästhesiol Intensivmed Notfallmed Schmerzther 2015; 50(9): 556-564
DOI: 10.1055/s-0041-102701
Fachwissen
Anästhesiologie: Topthema
© Georg Thieme Verlag Stuttgart · New York

Anästhesie und Organprotektion – Einfluss des anästhesiologischen Managements auf die intraoperative Neuroprotektion

Intraoperative neuroprotection – influence of the anaesthesiological management
Serge C Thal
,
Anne Sebastiani
Further Information

Publication History

Publication Date:
16 September 2015 (online)

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Zusammenfassung

Perioperative neurofunktionelle Störungen können u. a. als perioperativer Schlaganfall (POS) oder postoperatives kognitives Defizit (POCD) klinisch manifest werden. Da das Auftreten neurofunktioneller Störungen mit einer Verschlechterung der Prognose der Patienten assoziiert ist, stellt sich die Frage nach Möglichkeiten der Ursachenprävention bzw. Begrenzung der Symptomschwere und -dauer und den Möglichkeiten zur Verhinderung von Langzeitfolgen. Der Fokus des Übersichtsartikels liegt auf der Darstellung von Möglichkeiten, durch intraoperatives anästhesiologisches Management Inzidenz und Ausmaß neurologischer Komplikationen günstig zu beeinflussen, um das Behandlungsergebnis im Sinne des Patienten zu optimieren.

Abstract

Perioperative neurofunctional disorders may become clinically apparent as e. g. perioperative stroke (POS) or postoperative cognitive deficit (POCD). Newly diagnosed neuro-functional disorders are associated with worsening of postoperative outcome. Focus of this review article is on the possibilities of the intraoperative anaesthesiological management to favourably influence incidence and severity of neurological complications and to improve postoperative outcome.

Kernaussagen

  • Neurofunktionelle Störungen sind assoziiert mit einem ungünstigen Heilverlauf bis hin zu einer gesteigerten Mortalität.

  • Der perioperative Schlaganfall (POS) ist ein hoch relevantes Ereignis, das zu einer Verschlechterung der Prognose mit einer adjustierten 8-fachen Erhöhung der Mortalität führt.

  • Anästhetika und zerebrale Pathologien verändern den Regulationsbereich bzw. können die zerebrale Autoregulation aufheben.

  • Eine Analyse des Regulationsbereichs ist nur durch Bestimmung der dynamischen Veränderungen der zerebralen Autoregulation möglich.

  • Bei Hyperventilation (Hypokapnie) besteht aufgrund des vasokonstringierenden Effekts die Gefahr, dass die zerebrale Perfusion verringert und Hirnareale minderperfundiert werden.

  • Durch moderate Hyperkapnie kann die Gewebeperfusion im Gehirn, aber auch in anderen Organsystemen wie Darm und Haut verbessert werden.

  • Perioperative Hypo- und Hyperthermie der Patienten ist mit einem ungünstigen Heilverlauf vergesellschaftet.

  • Es existieren bisher keine Daten, ob eine intensivierte perioperative Insulintherapie die Inzidenz oder das Ausmaß von postoperativem kognitiven Defizit (POCD) oder POS verringert.

  • Es konnte eine Assoziation von POS bei einem Abfall des mittleren intraoperativen Blutdrucks um > 30 % gezeigt werden.

  • Bisher konnte für keines der gebräuchlichen Anästhetika in einer klinischen Studie ein neuroprotektiver Effekt nachgewiesen werden.

  • Die Steuerung der Sedierung mit intraoperativem BIS-Monitoring und die Vermeidung extrem niedriger BIS-Werte ist mit einer Reduktion der postoperativen Delirrate assoziiert.

  • Ein optimales Anästhesiemanagement sollte Normoxämie, -kapnie, -glykämie, -thermie und normale pH-Werte sowie einen für den individuellen Patienten „normalen“ Blutdruck anstreben und eine tiefe Sedierung vermeiden.

Schlüsselwörter:

anästhesiologischen Managements - neurologische Komplikationen - perioperativer Schlaganfall - postoperatives kognitives Defizit - Neuroprotektion

Key words:

anaesthesiological management - postoperative outcome - perioperative stroke - postoperative cognitive deficit - neuroprotection - intraoperative neuroprotection

Ergänzendes Material

 

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