FiO₂ bei Narkoseeinleitung, Eingriff und postoperativ

Zusammenfassung

Perioperativ wird allen Patienten Sauerstoff in unterschiedlichen Konzentrationen während einer Allgemeinanästhesie appliziert. Sauerstoff ist als Medikament einfach zuzuführen, leicht verfügbar und preisgünstig. Für die Wahl der inspiratorischen Sauerstoffkonzentration liegen weder national noch international akzeptierte Empfehlungen vor.

In den letzten Jahren zeigten viele Studien, dass die Wahl der Sauerstoffkonzentration nicht nur intraoperativ, sondern auch postoperativ den Heilungsverlauf nachhaltig beeinflussen kann.

Zu den Vorteilen einer hohen inspiratorischen intraoperativen Sauerstoffapplikation gehört eine Steigerung der Immunfunktion, eine geringere Wundinfektionsrate und eine geringere Inzidenz an postoperativer Übelkeit und Erbrechen. Zu den Nachteilen zählen die Ausbildung von Atelektasen durch eine hohe inspiratorische Sauerstoff-Fraktion, die aber behandelbar ist.

Abstract

All patients receive oxygen perioperatively during general anesthesia. It is easy to provide and releatively inexpensive. However, the oxygen concentration varies widely not only between different operation procedures but also between different countries. There is, so far, no general accepted guideline or agreement about an optimal inspiratory oxygen concentration. In the last years, many studies demonstrated that the choice of a certain inspiratory oxygen fraction influences not only the intraoperative but also the postoperative outcome of the patient. Supplemental oxygen improves immune function leading to a decreased rate of wound infections. In addition, a drop in the incidence of postoperative nausea and vomiting (PONV) was observed with a higher concnetration of oxygen. Unfavourable but inevitable is the formation of atelectasis induced by a high oxygen concentration.

Atelektasen - Wundinfektion - PONV

atelectasis - wound infection - PONV

Kernaussagen

• Es gibt bislang keine international anerkannten Empfehlungen für die inspiratorische Sauerstoffkonzentration (FiO₂) während einer Allgemeinanästhesie.

• Die Applikation höherer normobarer O₂-Konzentrationen kann die pulmonale Strombahn und das Lungenparenchym schädigen. Freie Sauerstoffradikale spielen eine Hauptrolle in der Pathophysiologie der Sauerstofftoxizität.

• Die Therapie mit zusätzlichem Sauerstoff kann bei Neonaten die Entstehung einer Retinopathie begünstigen. Hyperoxie und lange Beatmungsdauer steigern bei Kindern mit niedrigem Geburtsgewicht das Risiko einer zerebralen Lähmung.

• Die Applikation von 80 % Sauerstoff für<24 Stunden gilt allgemein bei gesunden Kindern und Erwachsenen als sicher.

• Die Präoxygenierung vor Allgemeinanästhesie schafft Sicherheitsreserven. Gelingt eine maximale Präoxygenierung nicht, so ist meist eine Leckage der Maske die Ursache.

• Atelektasen sind als Hauptkomplikation mit der O₂-Applikation assoziiert. Nach intraoperativem Recruitment begünstigt eine hohe FiO₂ die erneute Bildung von Atelektasen.

• Postoperativ verbessert die O₂-Therapie arterielle Sauerstoffsättigung und Herzfrequenz. Kardiale Komplikationen durch Hypoxämie und Tachykardie können verringert werden.

• Die O₂-Versorgung des Wundgebietes ist von großer Bedeutung für die Widerstandskraft gegen Infektionen.

• Die PONV-Inzidenz kann durch intraoperative Sauerstoffapplikation zumindest bei kolorektalen Eingriffen reduziert werden.

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