Thrombektomie beim Schlaganfall: anästhesiologische Aspekte

Zusammenfassung

Der Schlaganfall ist ein fokal-neurologisches Defizit auf dem Boden einer akuten Durchblutungsstörung. Therapieoptionen sind rt-PA-Lyse und neuroradiologische Thrombektomie. Letztere ist in Lokalanästhesie, Analgosedierung oder auch in Vollnarkose möglich. Dabei sollten wichtige (patho)physiologische und pharmakologische Aspekte in die anästhesiologische Versorgung von Schlaganfallpatienten einfließen, um das neurologische Ergebnis zu optimieren.

Abstract

Ischemic Stroke is a focal neurological deficit based on an acute ischemia. rt-PA lysis and thrombectomy are therapeutic options. Thrombectomy can be performed under local anaesthesia, sedation or general anaesthesia. Early studies clearly favoured sedation compared to general anaesthesia regarding neurological outcome. The following prospective, randomized trials could not detect harmful effects of general anaesthesia. Nonetheless in anaesthesia care of ischemic stroke patients many (patho-)physiological and pharmacological aspects should be taken into account for the best neurological outcome.

Kernaussagen

• Der Schlaganfall ist ein fokal-neurologisches Defizit auf dem Boden einer akuten Durchblutungsstörung.

• Therapieoptionen sind die rt-PA-Lyse und die neuroradiologische Thrombektomie.

• Die Thrombektomie ist sowohl in Lokalanästhesie, Analgosedierung als auch in Vollnarkose möglich.

• Erste retrospektive Untersuchungen zeigten einen Vorteil hinsichtlich des neurologischen Ergebnisses für die Versorgung in Analgosedierung.

• In nachfolgenden prospektiven und randomisierten Studien waren keine Nachteile durch eine Allgemeinanästhesie nachweisbar.

• In jedem Fall sind bei der anästhesiologischen Versorgung von Schlaganfallpatienten wichtige (patho)physiologische und pharmakologische Aspekte zu berücksichtigen, um das neurologische Ergebnis zu optimieren.

Schlüsselwörter

Thrombektomie - Schlaganfall - Anästhesie - Narkose

Key words

stroke - ischemia - anaesthesia - thrombectomy

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