Zusammenfassung
Gefäßchirurgische Patienten erfordern eine besondere perioperative Betreuung durch alle beteiligten Fachdisziplinen, weil die Gefäßveränderungen nur selten isoliert auftreten. Patienten mit einer pAVK weisen typische Merkmale und Begleiterkrankungen auf wie Hypercholesterinämie, arterieller Hypertonus, Diabetes mellitus, langjähriger inhalativer Tabakkonsum, männliches Geschlecht und eine positive Familienanamnese. Schlaganfall, Herzinfarkt sowie Durchblutungsstörungen der Beine und der Nieren sind Auswirkungen einer systemischen Gefäßerkrankung und haben damit einen direkten Einfluss auf das perioperative Risiko. Der gefäßchirurgische Patient ist deshalb häufig ein Patient mit erhöhtem Risiko und stellt an die perioperative Versorgung besondere Ansprüche. Der Anästhesist benötigt fundierte pathophysiologische Kenntnisse zu den jeweiligen Begleiterkrankungen, deren spezifischen Risiken und deren möglichen perioperativen Behandlungsoptionen.
Abstract
The vascular surgical patient is often a patient at increased risk and provides special perioperative care and requirements. Patients with peripheral arterial occlusive disease have concomitant diseases and characteristics such as hypercholesterolemia, hypertension, diabetes mellitus, longterm inhaled tobacco use, a male gender and a positive family history. Former cerebral ischaemia, heart attack and blood circulation problems in the legs and kidneys have a direct impact on the perioperative morbidity. For risk optimization the anaesthetist should have high theoretical and practical experience in the used anaesthetic techniques and a profound knowlege of the pathophysiological characteristics of the vascular procedures.
Literatur
Diehm C, Weiss T (2000) AVK-Fibel. 3 Aufl. Lingua Med-Verlag, Neu-Isenburg
Diehm C, Schuster A, Allenberg H et al (2004) High prevalence of peripheral arterial disease and co-morbidity in 6,880 primary care patients: cross sectional study. Atherosclerosis 172:95–105
Willigendael EM, Teijink JA, Bartelink ML et al (2004) Influence of smoking on incidence and prevalence of peripheral arterial disease. J Vasc Surg 40(6):1158–1165
(o A) (2010) Präoperative Evaluation erwachsener Patienten vor elektiven, nicht kardiochirurgischen Eingriffen. Anästh Intensivmed 11:788–796
Badner NH, Knill RL, Brown JE et al (1998) Myocardial infarction after non-cardiac surgery. Anesthesiology 88:572–578
King SB IIIrd, Smith SC Jr, Hirshfeld J et al (2008) Focused update of the ACC/AHA/SCAI 2005 Guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice guidelines. Circulation 117(2):261–295
Nijjer SS, Davies JE, Francis DP (2012) Quantitative comparison of clopidogrel 600 mg, prasugrel and ticagrelor, against clopidogrel 300 mg on major adverse cardiovascular events and bleeding in coronary stenting: synthesis of CURRENT-OASIS-7, TRITON-TIMI-38 and PLATO. Int J Cardiol 158(2):181–185
Kozek-Langenecker SA, Duris M, Rottmann B (2007) Antikoagulantien und deren Reversierung. Anästh Intensivmed 48:153
Sibbing D, Morath T, Stegherr J et al (2009) Impact of proton pump inhibitors on the antiplatelet effects of clopidogrel. Thromb Haemost 101:714–719
Bhatt DL, Cryer BL, Contant CF et al (2010) Clopidogrel with or without omeprazole in coronary artery disease. N Engl J Med 363:1909–1917
Hirsch AT, Treat-Jacobson D, Lando HA et al (1997) The role of tobacco cessation, antiplatelet and lipid-lowering therapies in the treatment of peripheral arterial disease. Vasc Med 2(3):243–251
Nair U, Thielmann HW, Pötschke-Langer M (2009) Krebserzeugende Substanzen im Tabakrauch. Deutsches Krebsforschungszentrum, Heidelberg. http://www.tabakkontrolle.de
Tang CS, Fan SZ, Chan CC (2001) Smoking status and body size increase carbon monoxide concentration in the breathing circuit during low-flow-anesthesia. Anesth Analg 92:542–547
Warner MA, Offord KP, Warner ME et al (1989) Role of preoperative cessation of smoking and other factors in postoperative pulmonary complications: a blinded prospective study of coronary artery bypass patient. Mayo Clin Proc 64(6):609–616
Sorensen LT, Hemmingsen U, Kallehave F et al (2005) Risk factors for tissue and wound complications in gastrointestinal surgery. Ann Surg 241:654–658
Subramaniam B, Panzica PJ, Novack V et al (2009) Continuous perioperative insulin infusion decreases major cardiovascular events in patients undergoing vascular surgery. Anesthesiology 110:970–977
Berghe G van den, Wouters P, Weekers F et al (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345:1359–1367
Griesdale DE, Souza RJ de, Dam RM van et al (2009) Intensive insulin therapy and mortality among critically ill patients: a meta analysis including NICE-SUGAR study data. CMAJ 180:821–827
Finfer S, Chittock DR, Su SY et al (2009) The NICE-SUGAR Study Investigators: intensive versus conventional glucose control in critically ill patients. N Engl J Med 360:1283–1297
Adler GK, Bonyhay I, Failing H et al (2009) Antecedent hypoglycemia impairs autonomic cardiovascular function: implications for rigorous glycemic control. Diabetes 58(2):360–366
American Diabetes Association (2005) Standards of medical care in diabetes. Diabetes Care 28(1):4–36
Williams TM, Harken AH (2008) Statins for surgical patients. Ann Surg 247:30–37
Mehler PS, Coll JR, Estacio R et al (2003) Intensive blood pressure control reduces the risk of cardiovascular events in patients with peripheral arterial disease and type 2 diabetes. Circulation 107(5):753–756
Hoeks SE, Scholte OP, Reimer WJ et al (2007) Increase of 1-year mortality after perioperative beta-blocker withdrawal in endovascular and vascular surgery patients. Eur J Vasc Endovasc Surg 33(1):13–19
Devereaux PJ, Yang H, Yusuf S et al (2008) Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 371:1839–1847
Barrett BJ, Parfrey PS (2006) Clinical practice. Preventing nephropathy induced by contrast medium. N Engl J Med 354(4):379–386
Kshirsagar AV, Poole C, Mottl A et al (2004) N-acetylcysteine for the prevention of radiocontrast induced nephropathy: a meta-analysis of prospective controlled trials. J Am Soc Nephrol 15:761–769
Barrett BJ, Parfrey PS (2006) Preventing nephropathy induced by contrast medium. N Engl J Med 354:379–386
Frank SM, Higgins MS, Breslow MJ et al (1995) The catecholamine, cortisol and hemodynamic responses to mild perioperative hypothermia: a randomized clinical trial. Anesthesiology 82:83–93
Frank SM, Fleisher LA, Breslow MJ et al (1997) Perioperative maintenance of normothermia reduces the incidence morbid cardiac events: a randomized clinical trial. JAMA 277:1127–1134
Kurz A, Sessler DI, Lenhardt R (1996) Perioperative normothermia to reduce the incidence of surgical wound infection and shorten hospitalization. N Engl J Med 334:1209–1215
Ng SF, Oo CS, Loh KH et al (2003) A comparative study of three warming interventions to determine the most effective in maintaining perioperative normothermia. Anesth Analg 96:171–176
Gauss A, Jahn SK, Eberhart LH et al (2011) Kardioprotektion durch thorakale Periduralanästhesie? Anaesthesist 60(10):950–962
Pöpping DM, Zahn PK, Van Aken HK et al (2008) Effectiveness and safety of postoperative pain management: a survey of 18,925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data. Br J Anaesth 101(6):832–840
Gogarten W, Van Aken H, Büttner J et al (2007) Rückenmarksnahe Regionalanästhesien und Thromboembolieprophylaxe/antithrombotische Medikation. Anästh Intensivmed 48:109–124
Rerkasem K, Rothwell PM (2009) Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). Cochrane Database Syst Rev 7(4):CD000190
Rerkasem K, Rothwell PM (2008) Local versus general anaesthesia for carotid endarterectomy. Cochrane Database Syst Rev 8(4):CD000126
Gelman S (1995) The pathophysiology of aortic cross-clamping and unclamping. Anesthesiology 82:1026–1057
Liason JL, Wainess RM, Proctor MC et al (2003) A national and single institutional experience in the contemporary treatment of acute lower extremity ischemia. Ann Surg 238:382–390
Sheridan GW, Matsen FA (1976) Fasciotomy in the treatment of the acute compartment syndrome. J Bone Joint Surg 58(1):112–115
Diener HC, Maier C (2009) Die Schmerztherapie, 3 Aufl. Elsevier, München
Hatzenbühler M, Fresenius M, Heck M (2007) Repetitorium Schmerzmedizin, 2 Aufl. Springer Verlag, Berlin Heidelberg New York Tokio
Halbert J, Crotty M, Cameron ID (2002) Evidence for the optimal management of acute and chronic phantom pain: a systematic review. Clin J Pain 18:84–92
(o A) (2008) Therapie neuropathischer Schmerzen. Leitlinien für Diagnostik und Therapie in der Neurologie, 4 überarbeitete Aufl., Thieme, Stuttgart, S 654 ff
(o A) (2009) S3-Leitlinie: Behandlung akuter perioperativer und posttraumatischer Schmerzen 2009, Deutsche Interdisziplinäre Vereinigung für Schmerztherapie. http://www.awmf.de (AWMF-Register Nr. 041/001)
Dertwinkel R, Heinrichs C, Senne I et al (2001) Prevention of severe phantom limb pain by perioperative administration of ketamine: an observational study. Acute Pain 4:12–16
Wilson JA, Nimmo AF, Fleetwood-Walker SM, Colvin LA (2008) A randomised blind trial of the effect of pre-emptive epidural ketamine on persistent pain after lower limb amputation. Pain 135:108–118
Jaeger H, Maier C (1992) Calcitonin in phantom limb pain: a double-blind study. Pain 48:21–27
Wall GC, Heyneman CA (1999) Calcitonin in phantom limb pain. Ann Pharmacother 33:499–501
Ahn C, Mulligan P, Salcido RS (2008) Smoking – the bane of wound healing: biomedical interventions and social influences. Adv Skin Wound Care 21:227–236
Guo S, Dipietro LA (2010) Factors affecting wound healing. J Dent Res 89:219–229
Zwissler B, Geldner G, Mertens E et al (2010) Präoperative Evaluation erwachsener Patienten vor elektiven, nichtkardiochirurgischen Eingriffen. Anaesthesist 59(11):1041–1050
(o A) (2008) Jusletter BDAkutell März 2008 Jahrgang 8, Ausgabe 1
Interessenkonflikt
Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rath, T., Kerner, T. Anästhesiologische Aspekte in der Gefäßmedizin. Gefässchirurgie 18, 28–34 (2013). https://doi.org/10.1007/s00772-012-1109-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00772-012-1109-1