Perioperatives Medikamentenmanagement – Langversion

Zusammenfassung

Das perioperative Management der Dauermedikation von Patienten, die sich chirurgischen Eingriffen unterziehen müssen, erfordert ein rechtzeitiges und interdisziplinäres Zusammenspiel der einzelnen medizinischen Fachdisziplinen. Patienten mit einer höhergradigen ASA- Klassifikation (Evaluierung nach der Klassifikation der American Society of Anesthesiologists) sind häufig multimorbide Patienten, die an einer Vielzahl internistischer Erkrankungen leiden und eine große Anzahl an Medikamenten zur Therapie dieser Erkrankungen einnehmen. Mit einer steigenden Anzahl dieser Substanzen kommt es auch zu häufiger auftretenden Arzneimittelinteraktionen.

In der perioperativen Phase kommen noch Wechselwirkungen mit inhalativen und intravenösen Anästhetika sowie spezifische Blutungskomplikationen hinzu, die bereits präoperativ berücksichtigt werden müssen.

Die vorliegende Arbeit hat das Ziel, das perioperative Management der internistischen Begleittherapie bei nichtkardiochirurgischen Patienten an Hand der aktuellen Evidenz zusammenzufassen. Besonders auf dem Gebiet der kardiovaskulären Medikation sind in den letzten Jahren Evidenz basierte Empfehlungen publiziert worden, hier vor allem im Bereich der Beta-Blocker Therapie. Für andere Substanzgruppen bestehen die Empfehlungen weiterhin häufig aus Expertenmeinungen, pharmakologischen Empfehlungen, Arzneimittelinteraktionen oder Fallberichten, da nur wenige randomisiert kontrollierte Studien zur Verfügung stehen. Die vorliegenden epidemiologischen Studien sind heterogen.

Abstract

The management of chronic medication in the perioperative phase represents as a serious challenge for the involved physicians. Especially patients with elevated ASA-scores frequently suffer from multiple co-morbidities which often need numerous medications. The probability of pharmacological interactions rises with the number of these medications. Moreover it must be taken into consideration that chronic medication potentially interferes with both intravenous and inhaled anesthetics and moreover, bleeding complications are more likely to occur in patients undergoing chronic pharmacotherapy.

The aim of this article is to provide a summary of the existing evidence concerning perioperative medication in patients undergoing non-cardiac surgery. Several guidelines and advisories dealing with cardiovascular medication have been published during the last decade. The main scope of these publications was on beta-blockers and other cardiovascular medication. There is less evidence on not-cardiovascular medication as in most cases only case reports and expert opinions are published. Existing epidemiologic studies on this topic are rather heterogeneous.

Schlüsselwörter

perioperative Medikation - Chirurgie - Dauertherapie - Risikomanagement - Patientensicherheit

Keywords

perioperative medication - surgery - chronic medication - risk management - patient safety

• Literatur

• 1 Andrade C, Sandarsh S, Chethan KB et al. Serotonin reuptake inhibitor antidepressants and abnormal bleeding: a review for clinicians and a reconsideration of mechanisms. J Clin Psychiatry 2010; 71: 1565-1575
• 2 Auerbach AD, Goldman L. beta-Blockers and reduction of cardiac events in noncardiac surgery: clinical applications. JAMA 2002; 287: 1445-1447
• 3 Ballwieser DA, Chappell D, Jacob M. Insulinresistenz: Bedeutung in der Anästhesie und Intensivmedizin – Perioperative Stoffwechselkontrolle bei Diabetikern und Nichtdiabetikern. Anasthesiol Intensivmed Notfallmed Schmerzther 2011; 46: 258-266
• 4 Baradari AG, Habibi MR, Khezri HD et al. Does high-dose metformin cause lactic acidosis in type 2 diabetic patients after CABG surgery? A double blind randomized clinical trial. Heart Int 2011; 6: e8
• 5 Barnett SR. Polypharmacy and perioperative medications in the elderly. Anesthesiology clinics 2009; 27: 377-389
• 6 Bauer SM, Cayne NS, Veith FJ. New developments in the preoperative evaluation and perioperative management of coronary artery disease in patients undergoing vascular surgery. J Vasc Surg 2010; 51: 242-251
• 7 Beattie WS, Wijeysundera DN, Karkouti K et al. Acute surgical anemia influences the cardioprotective effects of beta-blockade: a single-center, propensity-matched cohort study. Anesthesiology 2010; 112: 25-33
• 8 Biccard BM, Sear JW, Foex P. Acute peri-operative beta blockade in intermediate-risk patients. Anaesthesia 2006; 61: 924-931
• 9 Bock M, Wiedermann CJ, Motsch J et al. Minimizing cardiac risk in perioperative practice – interdisciplinary pharmacological approaches. Wien Klin Wochenschr 2011; 123: 393-407
• 10 Buhre K, de Rossi L, Buhre W. Präoperative Dauertherapie. Anaesthesist 2005; 54: 902-913
• 11 Buse GL, Bucher E, Seeberger MD et al. Chronische Medikation im Vorfeld operativer Eingriffe: absetzen – beibehalen – ausbauen?. Ther Umschau 2009; 66: 509-517
• 12 Castanheira L, Fresco P, Macedo AF. Guidelines for the management of chronic medication in the perioperative period: systematic review and formal consensus. J Clin Pharm Ther 2011; 36: 446-467
• 13 Copeland LA, Zeber JE, Pugh MJ et al. Postoperative complications in the seriously mentally ill: a systematic review of the literature. Ann Surg 2008; 248: 31-38
• 14 Coriat P, Daloz M, Bousseau D et al. Prevention of intraoperative myocardial ischemia during noncardiac surgery with intravenous nitroglycerin. Anesthesiology 1984; 61: 193-196
• 15 Cornia PB, Anawalt BD. Rational use of perioperative corticoid supplementation in patients at risk for acute adrenal insufficiency. Hospital Physician 2003; 48: 39-44
• 16 Cruickshank JM. Are we misunderstanding beta-blockers. Int J Cardiol 2007; 120: 10-27
• 17 De Baerdemaeker L, Audenaert K, Peremans K. Anaesthesia for patients with mood disorders. Curr Opin Anaesthesiol 2005; 18: 333-338
• 18 Devereaux PJ, Goldman L, Cook DJ et al. Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ 2005; 173: 627-634
• 19 Devereaux PJ, Yang H, Yusuf S et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 2008; 371: 1839-1847
• 20 Dierdorf SF. Anesthesia for patients with diabetes mellitus. Curr Opin Anaesthesiol 2002; 15: 351-357
• 21 Duncan AE, Abd-Elsayed A, Maheshwari A et al. Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery. Anesthesiology 2010; 112: 860-871
• 22 Duncan AI, Koch CG, Xu M et al. Recent metformin ingestion does not increase in-hospital morbidity or mortality after cardiac surgery. Anesth Analg 2007; 104: 42-50
• 23 Fleischmann KE, Goldman L, Young B et al. Association between cardiac and noncardiac complications in patients undergoing noncardiac surgery: outcomes and effects on length of stay. Am J Med 2003; 115: 515-520
• 24 Fleisher LA, Beckman JA, Brown KA et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. Circulation 2007; 116: e418-499
• 25 Fleisher LA, Beckman JA, Brown KA et al. 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2009; 120: e169-276
• 26 Fraser CG, Preuss FS, Bigford WD. Adrenal atrophy and irreversible shock associated with cortisone therapy. JAMA 1952; 149: 1542-1543
• 27 Goldberg PARM, Inzucchi SE. Clinical Results of an updated insulin infusion protocol in critically ill patients. Diabetes Spectrum 2005; 18: 188-191
• 28 Grant PJ, Wesorick DH. Perioperative medicine for the hospitalized patient. Med Clin North Am 2008; 92: 325-348, viii
• 29 Heck M, Fresenius M. Repetitorium Anästhesiologie. 5.. Auflage. 2007. Springer Verlag, Heidelberg;
• 30 Hindler K, Shaw AD, Samuels J et al. Improved postoperative outcomes associated with preoperative statin therapy. Anesthesiology 2006; 105: 1260-1272; quiz 1289-1290
• 31 Kalenka A, Hinkelbein J. Anästhesie bei Patienten mit Parkinson-Erkrankung. Anaesthesist 2005; 54: 401-409
• 32 Kheterpal S, Khodaparast O, Shanks A et al. Chronic angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy combined with diuretic therapy is associated with increased episodes of hypotension in noncardiac surgery. J Cardiothorac Vasc Anesth 2008; 22: 180-186
• 33 King Jr JT, Goulet JL, Perkal MF et al. Glycemic control and infections in patients with diabetes undergoing noncardiac surgery. Ann Surg 2011; 253: 158-165
• 34 Klimek M, Dammers R. Antiepileptic drug therapy in the perioperative course of neurosurgical patients. Curr Opin Anaesthesiol 2010; 23: 564-567
• 35 Kofke WA. Anesthetic management of the patient with epilepsy or prior seizures. Curr Opin Anaesthesiol 2010; 23: 391-399
• 36 Krolikowska M, Kataja M, Poyhia R et al. Mortality in diabetic patients undergoing non-cardiac surgery: a 7-year follow-up study. Acta Anaesthesiol Scand 2009; 53: 749-758
• 37 Kudoh A, Katagai H, Takazawa T. Antidepressant treatment for chronic depressed patients should not be discontinued prior to anesthesia. Can J Anaesth 2002; 49: 132-136
• 38 Lewis L, Robinson RF, Yee J et al. Fatal adrenal cortical insufficiency precipitated by surgery during prolonged continuous cortisone treatment. Ann Intern Med 1953; 39: 116-126
• 39 London MJ, Zaugg M, Schaub MC et al. Perioperative beta-adrenergic receptor blockade: physiologic foundations and clinical controversies. Anesthesiology 2004; 100: 170-175
• 40 Marks JB. Perioperative management of diabetes. Am Fam Physician 2003; 67: 93-100
• 41 Maynard G, O'Malley CW, Kirsh SR. Perioperative care of the geriatric patient with diabetes or hyperglycemia. Clin Geriatr Med 2008; 24: 649-665, viii
• 42 Mercado DL, Petty BG. Perioperative medication management. Med Clin North Am 2003; 87: 41-57
• 43 Miller RDEL, Fleisher LA, Wiener-Kronish JP, Young WL. Miller’s Anesthesia. 7th. Aufl: Churchill Livingstone; 2007
• 44 Miriam A, Korula G. A simple glucose insulin regimen for perioperative blood glucose control: the Vellore regimen. Anesth Analg 2004; 99: 598-602
• 45 Moghissi ES, Korytkowski MT, DiNardo M et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes care 2009; 32: 1119-1131
• 46 Network SIG. Sign 50 A guideline developer's handbook. revised edition 2008
• 47 Nicholson G, Burrin JM, Hall GM. Peri-operative steroid supplementation. Anaesthesia 1998; 53: 1091-1104
• 48 Olsen MA, Nepple JJ, Riew KD et al. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am 2008; 90: 62-69
• 49 Poldermans D, Bax JJ, Boersma E et al. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Eur Heart J 2009; 30: 2769-2812
• 50 Redel A, Schwemmer U. Perioperative Modifikation der Dauermedikation bei kardiovaskulären, pulmonalen und metabolischen Erkrankungen. Anasthesiol Intensivmed Notfallmed Schmerzther 2008; 43: 144-154
• 51 Rivera R, Antognini JF. Perioperative drug therapy in elderly patients. Anesthesiology 2009; 110: 1176-1181
• 52 Robertshaw HJ, Hall GM. Diabetes mellitus: anaesthetic management. Anaesthesia 2006; 61: 1187-1190
• 53 Roth A, Angster R, Forst H. Begleitmedikation – Notwendigkeit, Nebenwirkungen und Interaktionen in der perioperativen Phase. Anaesthesist 1999; 48: 267-283
• 54 Roth A, Angster R, Forst H. Begleitmedikation – Notwendigkeit, Nebenwirkungen und Interaktionen in der perioperativen Phase. Anaesthesist 1999; 48: 267-283
• 55 Saber W. Perioperative medication management: a case-based review of general principles. Cleve Clin J Med 2006; 73 (Suppl. 01) 82-87
• 56 Salpeter SR, Greyber E, Pasternak GA et al. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane database of systematic reviews 2010; DOI: DOI: 10.1002/14651858.CD002967.pub4. CD002967
• 57 Schiavi A, Papangelou A, Mirski M. Preoperative preparation of the surgical patient with neurologic disease. Med Clin North Am 2009; 93: 1123-1130
• 58 Schiff RL, Welsh GA. Perioperative evaluation and management of the patient with endocrine dysfunction. Med Clin North Am 2003; 87: 175-192
• 59 Schirmer U, Schurmann W. Zur perioperativen Gabe von ACE-Hemmern. Anaesthesist 2007; 56: 557-561
• 60 Smith I, Jackson I. Beta-blockers, calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers: should they be stopped or not before ambulatory anaesthesia?. Curr opin Anaesthesiol 2010; 23: 687-690
• 61 Stoelting RK, Hillier SC Hrsg. Pharmacology and Physiology in Anesthetic Practice. Second. Aufl: Lippincott Williams & Wilkins; 2006: 569-579
• 62 Tuttnauer A, Levin PD. Diabetes mellitus and anesthesia. Anesthesiology clinics 2006; 24: 579-597
• 63 Ueng J, Douketis JD. Prevention and treatment of hormone-associated venous thromboembolism: a patient management approach. Hematol Oncol Clin North Am 2010; 24: 683-694, vii-viii
• 64 van Haelst IM, Egberts TC, Doodeman HJ et al. Use of serotonergic antidepressants and bleeding risk in orthopedic patients. Anesthesiology 2010; 112: 631-636
• 65 Vogel Kahmann I, Ruppen W, Lurati Buse G et al. Langzeitmedikation und perioperatives Management. Internist 2011; 52: 89-98
• 66 Wallace AW, Au S, Cason BA. Association of the pattern of use of perioperative beta-blockade and postoperative mortality. Anesthesiology 2010; 113: 794-805
• 67 Wappler FTP, Bürkle H. Anästhesie und Begleiterkrankungen – Perioperatives Management des kranken Patienten. Thieme Verlag; 2006
• 68 Wijeysundera DN, Beattie WS. Calcium channel blockers for reducing cardiac morbidity after noncardiac surgery: a meta-analysis. Anesth Analg 2003; 97: 634-641
• 69 Wijeysundera DN, Bender JS, Beattie WS. Alpha-2 adrenergic agonists for the prevention of cardiac complications among patients undergoing surgery. Cochrane database of systematic reviews 2009; DOI: DOI: 10.1002/14651858.CD004126.pub2. CD004126
• 70 Wijeysundera DN, Naik JS, Beattie WS. Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications: a meta-analysis. Am J Med 2003; 114: 742-752
• 71 Wullner U, Kassubek J, Odin P et al. Transdermal rotigotine for the perioperative management of Parkinson's disease. J Neural Transm 2010; 117: 855-859