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Anästhesiol Intensivmed Notfallmed Schmerzther 2015; 50(07/08): 496-503
DOI: 10.1055/s-0041-103329
Fachwissen
Anästhesiologie: Topthema
© Georg Thieme Verlag Stuttgart · New York

Epiduralanästhesie – Komplikationen der Epiduralanästhesie – alte Zöpfe, neue Hüte

EnglischerTitel: Epidural anesthesia – complications and side effects
Tobias Schmidt
,
Manuel Wenk
Further Information

Publication History

Publication Date:
31 July 2015 (online)

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Zusammenfassung

Die thorakale Epiduralanästhesie als Goldstandard der intra- und postoperativen Analgesie ist bei einer Vielzahl von Eingriffen, unter Einhaltung definierter Sicherheitsstandards, ein zuverlässiges und sicheres Verfahren, bei dem es eher selten zu Komplikationen kommt. Treten jedoch Komplikationen auf, so gehen diese häufig mit schwerwiegenden Folgen für den Patienten einher. Neben den „klassischen“ Komplikationen der direkten bzw. indirekten Schädigung des Rückenmarks und/oder nervaler Strukturen wird aber auch immer wieder von prozeduralen Komplikationen bei der Anlage und Bestückung eines Epiduralkatheters berichtet. Diese prozeduralen Komplikationen ziehen häufig Folgeeingriffe und -behandlungen nach sich und erhöhen damit das Morbiditätsrisiko. Ziel dieser Übersichtsarbeit ist es daher, dem Leser einen aktuellen Überblick der Literatur zu den „klassischen“ Komplikationen zu verschaffen und darüber hinaus auf häufig nicht veröffentlichte prozedurale Komplikationen des Verfahrens der Epiduralanästhesie hinzuweisen.

Abstract

Thoracic epidural anesthesia remains the gold standard of intra- and postoperative analgesia for a multitude of surgical procedures as a reliable and relatively safe procedure with a low rate of complications as long as contraindications are respected. However, if complications do occur they often result in catastrophic sequelae for the patient. Apart from the well-known side-effects and complications there are innumerous reports about procedural complications during placement and use of the catheter. Procedural complications often result in additionally required procedures and treatments, hence increasing morbidity of the affected patient. The aim of this review is to provide the reader with a current overview of the available literature with regards to classical and procedural complications.

Kernaussagen:

  • Die Epiduralanästhesie ist für eine große Anzahl verschiedenster Eingriffe der Goldstandard der perioperativen Schmerztherapie und ist bei richtiger Anwendung ein sicheres und effektives Verfahren.

  • Neben den schwerwiegenden „klassischen“ Komplikationen sollten prozedurale Komplikationen, die den Anästhesisten im klinischen Alltag beschäftigen, mehr Beachtung finden.

  • Bei Verdacht auf eine epidurale Raumforderung sollte unverzüglich eine Diagnostik eingeleitet werden, um schwerwiegende Folgen zu vermeiden.

  • Prozedurale Komplikationen sind wahrscheinlich häufiger als „klassische“ Komplikationen.

  • Prozedurale Komplikationen können durch eine offene Fehlerkultur und Kommunikation eher vermieden werden.

  • Eine konsequente Überwachung der postoperativen Schmerztherapie hilft, Komplikationen frühzeitig zu erkennen und schwerwiegende Folgen zu vermeiden.

Schlüsselwörter:

Epiduralanästhesie - perioperative - Komplikationen,

Key words:

epidural anesthesia - complications - perioperative

Ergänzendes Material

 

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