Anästhesie und Organprotektion – Perioperative Myokardprotektion bei nicht kardiochirurgischen Eingriffen

Zusammenfassung

Aufgrund der demografischen Entwicklung unterziehen sich immer mehr ältere und kardial vorerkrankte Patienten einem nicht kardiochirurgischen operativen Eingriff. Das Risiko postoperativer Komplikationen, insbesondere myokardialer Ischämien, ist bei diesem Patientenkollektiv deutlich erhöht. Von großer Wichtigkeit ist hier eine sorgfältige präoperative Vorbereitung inklusive der Erhebung des individuellen perioperativen Risikos sowie der Anpassung der Begleitmedikation. Eine bestehende Therapie mit Betablockern und Statinen soll perioperativ fortgeführt werden. Der Umgang mit dualer Thrombozytenaggregationshemmung erfordert eine interdisziplinäre Abstimmung. Intraoperativ sollten sowohl Tachykardien als auch Hyper- und Hypotonien konsequent vermieden bzw. therapiert werden. Da perioperative Myokardinfarkte häufig asymptomatisch sind, ist die Diagnose erschwert. Im Rahmen des postoperativen Managements ist eine adäquate Analgesie besonders wichtig.

Abstract

Due to ongoing demographic changes more and more older patients with co-existent cardiac diseases undergo non-cardiac surgery. The risk of postoperative complications, notably myocardial ischemia, is raised in these patients. An accurate preparation before surgery including the risk profile and the management of co-medication is of paramount importance. Beta-blockers and statins should be continued perioperatively. The management of platelet aggregations inhibitors requires an interdisciplinary approach. During surgery, tachycardia as well as hypertension and hypotension should be treated consequently. Perioperative myocardial infarction is often asymptomatic and diagnosis can be difficult. Sufficient analgesia is important in postoperative care of patients with co-existing cardiac diseases.

Schlüsselwörter:

perioperativer Myokardinfarkt - Betablocker - Statine - transösophageale Echokardiografie - Analgesie

Key words:

perioperative myocardial infarction - beta-blocker - statins - transesophageal echocardiography - analgesia

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