Atemwegsmanagement – Vergleich verschiedener Leitlinien zum Management des schwierigen Atemwegs

Zusammenfassung

Das Management des schwierigen Atemwegs hat aufgrund seiner Relevanz für das Outcome der Patienten einen hohen Stellenwert in der Fort- und Weiterbildung in der Anästhesie. Ein Algorithmus kann als Plan für eine schwierige Situation gesehen werden. Seit 1993 haben zahlreiche Fachgesellschaften Leitlinien zum Atemwegsmanagement herausgegeben. Die Leitlinien von ASA und DGAI haben neben vielen inhaltlichen Übereinstimmungen auch relevante Unterschiede im Vorgehen. Während die DGAI verschiedene Algorithmen für erwartet und unerwartet schwierigen Atemweg vorschlägt, hat die ASA einen universellen Algorithmus. Extraglottische Atemwegshilfen und Videolaryngoskopie sind mittlerweile fester Bestandteil der Algorithmen. Der Erhalt der Spontanatmung wird beim erwartet schwierigen Atemweg von der DGAI anders als bei der ASA als zwingend vorausgesetzt. Die Leitlinie der DGAI ist beim erwartet schwierigen Atemweg, der Strategie zur Extubation und in Bezug auf die Ausbildung wesentlich konkreter als die ASA.

Abstract

Due to its relevance to patient outcome, management of the difficult airway is a major topic in the training of anesthesiologists. Algorithms may serve as a plan for a difficult situation. Since 1993, many professional organizations have published guidelines for airway management. ASA and DGAI share common strategies in their guidelines, but also have significant differences. The DGAI provides different algorithms for both the anticipated and unanticipated difficult airway, while the ASA uses one universal algorithm. Extraglottic airway devices and video laryngoscopes are integral part of all these algorithms. In the DGAI guideline, spontaneous breathing is essential, in contrast to the ASA algorithm. Furthermore, the DGAI guideline is much more specific than the ASA guideline in regard to the anticipated difficult airway, extubation strategy and continuing training of anesthesiologists.

Schlüsselwörter:

schwieriger Atemweg - Atemwegsmanagement - Leitlinie Atemwegsmanagement - Atemwegshilfen

Key words:

difficult airway - airway management - guideline airway management - airway devices

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