Perioperative Risiken und Therapie bei Epilepsiepatienten

Zusammenfassung

Operative Eingriffe aller Art sind bei Patienten mit Epilepsien mit speziellen Risiken verbunden. Interaktionen zwischen antikonvulsiver und anästhesiologischer Medikation, prokonvulsive Effekte vieler gebräuchlicher Anästhetika und Gerinnungsstörungen unter Valproattherapie stellen die häufigsten Ursachen von Komplikationen dar. Zusätzliche Problemstellungen ergeben sich aufgrund der Senkung der Anfallsschwelle durch neurochirurgische Eingriffe. In einer Übersicht werden häufige Fragestellungen zur perioperativen Steuerung der Medikation bei Epilepsiepatienten und pragmatische Konzepte zur Risikominderung dargestellt.

Abstract

Surgical interventions are associated with particular risks in patients with epilepsy. Possible interactions between the anticonvulsive treatment and anaesthetic drugs, proconvulsive effects of commonly used anaesthetic drugs, and disturbances of hemostasis due to valproate may cause complications. Additional problems may arise due to the lowered seizure threshold following neurosurgical interventions. An overview on common problems and pragmatic concepts for the handling of epilepsy patients are provided.

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