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„Schlaf-Wach-Schlaf“-Technik zur CS Wachkraniotomie

“Asleep-awake-asleep”-anaesthetic technique for awake craniotomy

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Zusammenfassung

Wachkraniotomien in der Tumor- und Epilepsiechirurgie oder bei der stereotaktischen Elektrodenimplantation für die tiefe Hirnstimulation erfordern spezifische anästhesiologische Strategien. Mit Propofol werden kurze Aufwachzeiten sichergestellt, und die respiratorische Funktion des üblicherweise spontan atmenden Patienten wird nur wenig beeinträchtigt. Die Schmerzausschaltung sollte primär durch einen Hemiskalpblock bei großflächiger Trepanation oder eine lokale Anästhetikainfiltration bei der Tiefenelektrodenimplantation erfolgen. Zusätzlich kann bei einer Trepanation (Tumor- oder Epilepsiechirurgie) Remifentanil in niedriger Dosierung empfohlen werden. Durch einen transnasal eingeführten Tubus, dessen Spitze unter der Epiglottis platziert wird, kann der Atemweg frei gehalten werden. Zum Schutz vor Erbrechen ist eine ausreichende antiemetische Prophylaxe erforderlich.

Abstract

Awake craniotomy in tumor and epilepsy surgery or for the implantation of electrodes for deep brain stimulation requires specific anesthesiological strategies. Propofol allows for quick emergence and has little effect on the respiratory function of the usually spontaneously breathing patient. Pain control may be instituted by hemiscalp block for trepanation or local infiltration for deep brain electrode implantation. In addition, low dose remifentanil is recommended for trepanation (i.e. tumor or epilepsy surgery). The airway may be secured by an ordinary Magill tube placed transnasally with its tip underneath the epiglottis. To protect the patient against vomiting an adequate antiemetic prophylaxis is required.

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Danksagung

Die Autoren danken Frau Dörte Kordts für die Erstellung der Abbildungen 2 und 3.

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

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Authors and Affiliations

  1. Kliniken für Anästhesiologie und operative Intensivmedizin, Campus Virchow-Klinikum und Campus Charité Mitte, Universitätsmedizin, Augustenburger Platz 1, 13353 , Berlin

    U. Schulz, D. Keh, G. Fritz, C. Barner, T. Kerner &  W. Boemke

  2. Klinik für Neurochirurgie, Campus Virchow-Klinikum, Charité, Universitätsmedizin, Berlin

    G.-H. Schneider

  3. Klinik für Neurologie, Campus Virchow-Klinikum, Charité, Universitätsmedizin , Berlin

    T. Trottenberg & A. Kupsch

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  1. U. Schulz
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  2. D. Keh
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  3. G. Fritz
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  4. C. Barner
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  5. T. Kerner
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  6. G.-H. Schneider
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  7. T. Trottenberg
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  8. A. Kupsch
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  9. W. Boemke
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Correspondence to W. Boemke.

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Schulz, U., Keh, D., Fritz, G. et al. „Schlaf-Wach-Schlaf“-Technik zur CS Wachkraniotomie. Anaesthesist 55, 585–598 (2006). https://doi.org/10.1007/s00101-006-1023-6

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  • DOI: https://doi.org/10.1007/s00101-006-1023-6

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