Intraoperative Hypotonie: Bedeutung und Monitoring in der klinischen Praxis

Zusammenfassung

Intraoperative Hypotonie ist im klinischen Alltag keine Seltenheit. Obwohl ein Zusammenhang mit erhöhter perioperativer Morbidität und Letalität zu bestehen scheint, wird sie oft zu spät oder gar nicht therapiert. Dabei gibt es eine Vielzahl an Prädiktoren und technischen Hilfsmitteln, um Risikopatienten zu identifizieren und das perioperative Management durch ein adäquates Monitoring und eine frühzeitige Therapie zu optimieren.

Abstract

• Despite the high incidence of hypotension after anesthesia induction, awareness of the need to adequately and above all rapidily treat this condition is not always present in clinical practice.

• There is strong evidence that even a short episode of perioperative hypotension can significantly increase morbidity and mortality.

• Many risk factors for the occurrence of hypotension are known. Patients should be closely monitored and rapidly treated.

• In patients at risk, the average arterial blood pressure should not exceed of 80 mmHg perioperatively.

• Pre-existing hypovolemia enhances hypotension after anesthesia induction. Since many predictors are known, these should be applied and the volume status optimized before initiation of anesthesia.

• Ultrasound procedures can be used to quickly assess critical circulatory conditions.

• To predict hypotension after anesthesia, the "collapseability index" of the inferior vena cava is most likely to be used.

• Even a less experienced user can judge the presence of severely restricted cardiac function. The RUSH protocol has a high sensitivity and specificity for differentiating different forms of shock.

Kernaussagen

• Trotz der hohen Inzidenz einer Hypotonie nach Narkoseinduktion scheint das Bewusstsein für deren adäquate und v. a. rasche Therapie im klinischen Alltag nicht immer vorhanden zu sein.

• Es gibt starke Hinweise darauf, dass selbst eine kurze perioperative Hypotonie die Morbidität und Letalität deutlich erhöhen kann.

• Viele Risikofaktoren für das Auftreten einer Hypotonie sind bekannt. Die betroffenen Patienten sollten engmaschig überwacht und rasch therapiert werden.

• Bei Risikopatienten sollte ein mittlerer arterieller Blutdruck von 80 mmHg perioperativ nicht unterschritten werden.

• Eine vorbestehende Hypovolämie verstärkt die Hypotonie nach Narkoseinduktion. Da viele Prädiktoren bekannt sind, sollten diese angewandt und der Volumenstatus vor der Einleitung optimiert werden.

• Mithilfe von Ultraschallverfahren können kritische Kreislaufsituationen rasch beurteilt werden.

• Zur Prädiktion einer Hypotonie nach Narkoseeinleitung kann am ehesten der „Collapsability Index“ der V. cava inferior herangezogen werden.

• Eine schwer eingeschränkte Herzfunktion kann i. d. R. auch vom wenig geübten Anwender beurteilt werden.

• Das RUSH-Protokoll besitzt eine hohe Sensitivität und Spezifität zur Differenzierung verschiedener Schockformen.

Schlüsselwörter

Hypotonie - Monitoring - Prädiktion - intraoperativ - Diagnostik - Sonografie

Key words

hypotension - monitoring - prediction - intraoperative - diagnostics - sonography

^* Beide Autoren haben gleichermaßen zur Erstellung des Manuskripts beigetragen (geteilte Erstautorenschaft).

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