Neurologische Komplikationen in der Anästhesiologie – Teil I – Schlaganfall, Visusverlust, zentral anticholinerges Syndrom

Zusammenfassung

Neurologische Komplikationen nach Allgemein- und Regionalanästhesien verschlechtern das postoperative Outcome der Patienten, führen durch zusätzliche und erweiterte Diagnostik sowie eine längere Hospitalisationsdauer zu steigenden Kosten und beeinflussen die Patientenzufriedenheit nachhaltig. Die Inzidenz neurologischer Komplikationen kann durch gezielte Präventionsmaßnahmen und ein optimales anästhesiologisches Management reduziert werden. Eine rasche interdisziplinäre Zusammenarbeit bei auftretenden neurologischen Komplikationen ist für Diagnose und Therapie entscheidend und kann Patienten vor dauerhaften Schäden bewahren. Der vorliegende Artikel behandelt schwerpunktmäßig wichtige zentrale neurologische Komplikationen nach einer Allgemeinanästhesie. Der perioperative Schlaganfall (POS) und der postoperative Visusverlust (POVL) zählen zu schweren Komplikationen mit zum Teil fatalen Verläufen. Das zentral anticholinerge Syndrom (ZAS) ist ein inzwischen rares Ereignis, dessen Symptomatik und Therapie jedoch jedem Anästhesisten bekannt sein sollten.

Abstract

Neurological complications following anesthesia deteriorate patients' outcome, and increase hospital costs because of prolonged hospitalization and supplemental medical care. Moreover, patients' satisfaction is negatively influenced by neurological sequelae after anesthesia.

Improving anesthesiologic management based on consequent prevention measures can help to reduce the incidence of neurological complications after anesthesia. In case of neurological complications in the perioperative phase an interdisciplinary approach in immediate diagnosis and treatment may prevent patients from permanent damage. The present review article gives an overview over incidences, diagnostic and therapeutic issues of neurologic complications in operative patients, such as perioperative stroke, postoperative visual loss and the anticholinergic syndrome.

Schlüsselwörter:

neurologische Komplikationen - perioperativer Schlaganfall - perioperativer Visusverlust - zentral anticholinerges Syndom

Keywords:

neurologic complications - perioperative stroke - postoperative visual loss - anticholingeric syndrom

Kernaussagen

• Thromboembolisch ischämische Ereignisse sind die häufigste Ursache für einen perioperativen Schlaganfall.

• Die rasch erfolgende intraarterielle Lyse und / oder transarterielle Embolektomie kann eine therapeutische Option in der Behandlung eines perioperativen Schlaganfalls darstellen.

• Anästhesiologische Manipulationen am Hals, hypotone Kreislaufsituationen sowie die Patientenlagerung sollten ständig kritisch in Bezug auf die mögliche Verursachung eines Schlaganfalls geprüft werden.

• Die Empfehlungen der ASA-Task-Force zur Verhinderung von POVL sollten berücksichtigt werden.

• Bei Auftreten von postoperativen Visusstörungen muss eine sofortige ophthalmologische und neurologische Befunderhebung erfolgen.

• Das zentral anticholinerge Syndrom ist in der modernen Anästhesie eine eher seltene Komplikation und kann durch Gabe von Physostigmin effektiv behandelt werden.

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