Zusammenfassung
Hintergrund
Gegenwärtig gibt es keinen nationalen Standard zur ambulanten anästhesiologischen Betreuung von Patienten mit obstruktivem Schlafapnoesyndrom (OSAS). Ziel dieser Studie war es, mithilfe einer Umfrage die verschiedenen anästhesiologischen Vorgehensweisen in Deutschland zu erfassen und abzubilden.
Methoden
Die Datenerhebung erfolgte mithilfe eines Onlinefragebogens. Per E-Mail wurden 12.113 Mitglieder der unterstützenden Fachgesellschaften zur Teilnahme aufgefordert. Ein Hyperlink in dieser E-Mail ermöglichte den Zugriff auf den Onlinefragebogen. Gleichzeitig wurde in einer Fachzeitschrift zur Studienteilnahme aufgerufen.
Ergebnisse
Insgesamt konnten 1671 Fragebogen ausgewertet werden. Das Durchschnittsalter der Teilnehmer lag bei 45 Jahren; es waren 64% männlich und 36% weiblich. Sie verfügten im Schnitt über 16 Jahre Berufserfahrung. Von den Teilnehmern waren 85% Fachärzte. Insgesamt waren 85% der Teilnehmer überwiegend stationär, 12% überwiegend ambulant tätig. Allgemein bevorzugen 63% bei Patienten mit OSAS eine Regionalanästhesie, 20% eine Allgemeinanästhesie und 17% kein bestimmtes Verfahren. Ambulante Operationen in Regionalanästhesie werden von 72% und in Lokalanästhesie mit Sedierung von 55% der Befragten bei Patienten mit OSAS durchgeführt. Einer ambulanten Operation in Allgemeinanästhesie stimmten 49% und bei Eingriffen im Bereich der Atemwege 14% der Antwortenden zu. Im Vergleich befürworten die überwiegend ambulant tätigen Anästhesisten eher ambulante Operationen bei Patienten mit OSAS, führen diese signifikant häufiger in Allgemeinanästhesie durch, gaben signifikant kürzere Überwachungszeiten an und beobachtetn signifikant weniger Komplikationen als ihre überwiegend stationär tätigen Kollegen.
Schlussfolgerung
Die Umfrage zeigt, dass die ambulante Anästhesie bei Patienten mit OSAS in Deutschland gängige Praxis ist. Sie erfolgt auch bei Patienten mit moderatem oder schwerem OSAS sowie bei Operationen an den Atemwegen. Damit entspricht das Vorgehen nicht den Guidelines der American Society of Anesthesiologists (ASA).
Abstract
Background
In Germany there is currently no national standard for the management of patients with obstructive sleep apnea syndrome (OSAS). The object of this survey was to obtain information on the treatment concept for patients with OSAS and to report on the current practice in Germany.
Methods
Data collection was obtained through an online questionnaire. A total of 12,113 members of the supporting anesthesia societies from all over Germany were invited to participate via e-mail. Additionally an announcement was made in a professional journal.
Results
A total of 1,671 questionnaires were analyzed. The average age of the respondents was 45 years, 64% were male and 36% were female. The average work experience was 16 years and 85% of the respondents were consultants. In total 85% of anesthesiologists were predominantly working in inpatient care and 12% were predominantly active in outpatient care. Of the respondents 63% preferred regional anesthesia, 20% preferred general anesthesia for patients with OSAS and 17% did not have a preference for a specific anesthesia procedure. Outpatient surgery for patients with OSAS was performed by 72% of the respondents using regional anesthesia and by 55% of the respondents using local anesthesia with sedation. Of the anesthesiologists 49% consented to outpatient surgery using general anesthesia and 14% to interventions involving the airways. Compared to anesthesiologists working predominantly in inpatient departments, those working predominantly in outpatient departments treated patients with OSAS more frequently on an outpatient basis, used general anesthesia significantly more often, discharged those patients significantly earlier and observed less complications.
Conclusions
This survey shows that outpatient surgery for patients with sleep apnea is common practice in Germany. It is also performed when patients have moderate or severe OSAS and for respiratory tract surgery. This means that the management is not conform to the guidelines of the American Society of Anesthesiologists (ASA).
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Danksagung
Wir danken allen Teilnehmern, der Reinhard Löwenstein Stiftung sowie dem Berufsverband Deutscher Anästhesisten (BDA) und der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) für ihre Unterstützung.
Interessenkonflikt
Die Autoren weisen auf folgende Beziehungen hin: Die Umfrage wurde finanziell durch die Reinhard Löwenstein Stiftung unterstützt.
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Saur, P., Roggenbach, J., Meinl, S. et al. Ambulante Anästhesie bei Patienten mit obstruktivem Schlafapnoesyndrom. Somnologie 16, 242–250 (2012). https://doi.org/10.1007/s11818-012-0563-z
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DOI: https://doi.org/10.1007/s11818-012-0563-z