Zusammenfassung
Die präoperative Risikoevaluation spielt eine wichtige Rolle für die Sicherheit von
Anästhesien. Ziel dieses Artikels ist eine Anleitung zur fokussierten Risikoevaluation
und Anordnung weiterer diagnostischer und therapeutischer Maßnahmen bei erwachsenen
Patienten vor elektiven, nicht herz-thoraxchirurgischen Eingriffen.
Abstract
With patient safety being anesthesiologistsʼ top priority, the focus of preoperative
assessment must be to reduce perioperative morbidity and mortality of each patient
entrusted to us. Perioperative risk is multifactorial and depends on the extent of
surgery and the preoperative condition of the patient.
The three main causes of unexpected perioperative death are cardiac arrest, hypoxemia
and acute bleeding. Therefore, cardiac and pulmonary risk assessment should cover
pre-existing conditions, patientʼs functional capacity and risk factors associated
with the surgical procedure. Specific assessment tools have been developed, are easily
accessible and have proven effective in every day clinical practice. Regarding the
risk of bleeding, taking a detailed patientsʼ history (including medication) seems
to be more suitable to detect mild bleeding disorders than laboratory screening.
Functional capacity, defined as the patientʼs ability to cope with everyday life,
gains importance in preoperative risk assessment, as do further factors like deficiencies
in nutrition, anaemia, physical capacity, the metabolic status or frailty in the elderly.
Prehabilitation strategies reduce perioperative mortality and morbidity by improving
functional capacity. These include preoperative nutrition supplementation, physical
exercise, correction of iron deficiency and optimized treatment of hyperglycemia.
A combination of thorough risk stratification and prehabilitation strategies can improve
preoperative conditions and reduce complications in the postoperative period.
Schlüsselwörter
präoperative Risikoevaluation - Prähabilitation - funktioneller Status
Key words
preoperative assessment - prehabilitation - functional capacity
