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Noceboeffekte und Negativsuggestionen in der Anästhesie

Nocebo effects and negative suggestion in anesthesia

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Zusammenfassung

Anästhesisten haben nicht nur durch Medikamente, Interventionen und Behandlungen Wirkung auf Patienten und ihre Heilung, sondern wesentlich auch durch ihre Worte und ihre Person. Ein erheblicher Teil der beobachteten Nebenwirkungen ist durch Noceboeffekte und Negativsuggestionen, d. h. durch den Arzt und die medizinische Umgebung bedingt. Jedes Symptom einer Krankheit, jede Nebenwirkung oder Komplikation kann durch ein falsches Sprechen darüber induziert werden. Für Patienten sind medizinische Situationen wie ein Notfall, eine Narkose oder eine Intensivtherapie extrem und z. T. existenziell bedrohlich. Dies bringt sie in einen veränderten Bewusstseinszustand, der sie für Negativsuggestionen besonders empfänglich macht. Suggestionen beeinflussen nicht nur psychische Funktionen wie Angst und Schmerz, sondern auch körperliche. Starke, bildhafte Worte, Doppeldeutigkeiten, Missverständnisse, unbedachte Gespräche, Fachjargon und Risikoaufklärung bilden mannigfaltige Negativsuggestionen. Nicht die medizinische Aufklärung, sondern die Art der Aufklärung gehört auf den Prüfstand. Durch das Wissen um Noceboeffekte und Negativsuggestionen können diese besser erkannt und vermieden werden. Diese Negativeinflüsse wirken im Kontext, d. h. in Abhängigkeit von individueller Vorgeschichte und Ängsten des Patienten sowie von dem entstandenen Vertrauensverhältnis. Der beste Schutz vor Schäden durch Aufklärung und Negativsuggestionen ist die tragfähige therapeutische Beziehung.

Abstract

Anesthetists have an impact on patients and healing processes not only through drugs, interventions and therapy but also significantly by their words and personality. A substantial part of observed side effects is caused by nocebo effects and negative suggestion, i.e. by the doctor and the medical surroundings. Every symptom of an illness, side effect or complication can also be induced by the wrong way of talking about it. Patients perceive medical situations, such as an emergency, anesthesia or intensive care as extreme or even as life-threatening. This can induce a natural trance, an altered state of consciousness characterized by increased suggestibility. Suggestions affect mental functions, such as anxiety and pain as well as physical functions. Strong figurative words, ambiguity, misunderstandings, incidental conversations, medical jargon and risk information are prone to generate negative suggestion. Not the informed consent per se but the way it is presented should be under scrutiny. Knowledge about nocebo effects and negative suggestion can help recognize and avoid these more easily. These negative factors depend on the context, i.e. they are strongly influenced by the individual background history and anxieties of the patient and also by the physician-patient relationship. The best protection against harm from informed consent and negative suggestion is a supportive therapeutic relationship.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. N. Zech, M. Seemann, E. Hansen geben an, dass kein Interessenkonflikt besteht. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigten oder des gesetzlich bestellten Betreuers vor. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Anästhesiologie, Universitätsklinikum Regensburg, 93042, Regensburg, Deutschland

    N. Zech, M. Seemann &  E. Hansen

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  1. N. Zech
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  2. M. Seemann
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  3. E. Hansen
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Correspondence to E. Hansen.

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Zech, N., Seemann, M. & Hansen, E. Noceboeffekte und Negativsuggestionen in der Anästhesie. Anaesthesist 63, 816–824 (2014). https://doi.org/10.1007/s00101-014-2386-8

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  • DOI: https://doi.org/10.1007/s00101-014-2386-8

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