Anästhesie und Outcome: Einfluss bei Kindern

Zusammenfassung

Die operative Versorgung von Kindern birgt ein erhöhtes Risiko schwerer perioperativer Komplikationen und stellt hohe Anforderungen an die beteiligten Berufsgruppen. Um das perioperative Outcome von Kindern vonseiten der Anästhesie positiv zu beeinflussen, sind neben der Optimierung institutioneller Faktoren individuelle Möglichkeiten innerhalb der intraoperativen Phase der Narkoseeinleitung und -aufrechterhaltung bedeutend, insbesondere die Einstellung des adäquaten Blutdrucks.

Abstract

The perioperative care of children is challenging for health care providers. Since anesthetists cannot affect the nature of the disease and have hardly an impact on the decision for surgery we summarized in this review individual and institutional factors for improving perioperative outcome by anesthetists. Individual factors include the level of education and the professional experience of the anesthetist as well as an anesthetic management that is focused on the maintenance of an adequate cerebral perfusion. Besides individual factors this review emphasizes the importance of institutional factors as measures to reduce anxiety and insecurity of the parents which result in less distress and coping of the children in the postanesthesia care unit as well as less need for pain medication, less emergence delirium and less sleep disorders. A behaviorally oriented preoperative preparation of parents and children also affects the postoperative course of the pediatric patients positively as well as institutional concepts for the reduction of perioperative medication errors and adverse drug events. We believe that perspectively pediatric surgery will be increasingly performed in high volume hospitals which are able to guarantee beneficial institutional structures as well as a high educational level and high professional experience of the employed anesthetists.

Kernaussagen

• Eine verhaltensorientierte präoperative Vorbereitung von Eltern und Kindern wirkt sich positiv auf den postoperativen Verlauf der Kinder aus.

• Maßnahmen zur Reduktion von Angst und Unsicherheit der Eltern sind im postoperativen Verlauf verbunden mit geringerem Schmerzmittelbedarf, weniger Emergence Delir und weniger Schlafstörungen.

• Ein hohes Fallaufkommen und die Erfahrung des Anästhesisten wirken sich positiv aus hinsichtlich der Anzahl intraoperativer Herzstillstände, Vermeidung von Atemwegskomplikationen sowie der Häufigkeit postoperativer Komplikationen.

• Institutionelle Konzepte zur Reduktion von Medikationsfehlern beeinflussen das Behandlungsergebnis positiv.

• Zur Aufrechterhaltung einer ausreichenden zerebralen Perfusion sollen Hypotensionen vor allem in Verbindung mit p_aCO₂- und Hb-Abfällen vermieden werden.

• „Failure to Rescue“ ist abhängig vom Fallaufkommen der Klinik. Hohe Fallzahlen wirken sich positiv aus.

• Zwischenergebnisse von GAS- und PANDA-Studie zeigen, dass die einmalige kurze Exposition gegenüber Anästhetika nicht zu einer Verschlechterung der neurologischen Entwicklung führt.

• Das Verzögern einer klar indizierten chirurgischen oder diagnostischen Prozedur in Allgemeinanästhesie bei Kindern ist nach aktueller Datenlage nicht zu rechtfertigen

Schlüsselwörter

Kinderanästhesie - Outcome - Eltern - Neurotoxizität - Anästhetika - Hypotension - Hypokapnie - institutionelle Faktoren

Key words

pediatric anesthesia - outcome - parents - neurotoxicity - anesthetics - hypotension - hypocapnia - institutional factors

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