Der Anaesthesist

, Volume 54, Issue 9, pp 902–913 | Cite as

Präoperative Dauertherapie

Klinische Pharmakologie

Zusammenfassung

Ein Großteil der Patienten, die sich chirurgischen Eingriffen unterziehen, nimmt bereits präoperativ Medikamente ein. Nur bei einem Teil der Patienten steht die Medikamenteneinnahme in direkter Beziehung zum geplanten chirurgischen Eingriff. Der überwiegende Teil erhält eine Dauermedikation aufgrund vorbestehender Erkrankungen. Im Vordergrund stehen dabei behandlungspflichtige Erkrankungen des kardiovaskulären, pulmonalen und endokrinologischen Systems. Die Anzahl und die Art der präoperativen Pharmakotherapie ist mit dem Alter des Patienten, der Komorbidität und dem Geschlecht korreliert. Darüber hinaus erhalten Patienten höherer ASA-Klassen mehr Medikamente, da sie häufiger unter Erkrankungen des kardiovaskulären, pulmonalen, neurologischen und endokrinologischen Formenkreises leiden. Der Umgang mit der präoperativen Dauertherapie ist für die Planung des anästhesiologischen und auch des chirurgischen Vorgehens von praktischer Bedeutung. Insbesondere auf dem Gebiet der gerinnungsaktiven Substanzen und anderer Medikamente, die abgesetzt oder umgestellt werden sollten, ist eine enge Kooperation der beteiligten Disziplinen erforderlich. In dieser Übersicht wird der Umgang mit der präoperativen Medikation für die wichtigsten Krankheitsbilder und Organsysteme besprochen und anhand der zur Verfügung stehenden Literatur kritisch diskutiert.

Schlüsselwörter

Präoperative Dauertherapie Anästhesie Regionalanästhesie Komorbidität Begleitmedikation 

Preoperative long-term therapy

Abstract

A large number of patients undergoing elective surgical procedures already take routine medication preoperatively. The majority of these patients use drugs for therapy of preexisting cardiovascular, pulmonary or endocrinological diseases which are independent of the planned surgical procedure. The number and type of preoperative drug therapy are correlated to age, gender and co-morbidity of the patients. Furthermore, patients with higher ASA-classes usually take more drugs, as they suffer from several medical diseases. Information about the perioperative handling of routine drug therapy is important for the planning of anaesthesia and surgery. A close cooperation of all medical specialities involved is necessary, in particular when patients take anticoagulants or other substances which should be withdrawn or replaced. This review focuses on the handling of routine preoperative medication by the anaesthesiologist in the light of available literature.

Keywords

Preperative drug therapy Anaesthesia Regional anaesthesia Co-morbidity Co-medication 

Notes

Interessenkonflikt:

Keine Angaben

Literatur

  1. 1.
    Ahmed Z, Lockhart CH, Weiner M et al. (2005) Advances in diabetic management: implications for anesthesia. Anesth Analg 100(3):666–669CrossRefPubMedGoogle Scholar
  2. 2.
    Amorosi SL, Tsilimingras K, Thompson D et al. (2004) Cost analysis of „bridging therapy“ with low-molecular-weight heparin versus unfractionated heparin during temporary interruption of chronic anticoagulation. Am J Cardiol 93(4):509–511CrossRefPubMedGoogle Scholar
  3. 3.
    Antithrombotic Trialists‘ Collaboration (2002) Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 324(7329):71–86CrossRefPubMedGoogle Scholar
  4. 4.
    Balser JR (2002) Perioperative arrhythmias: incidence, risk assessment, evaluation, and management. Card Electrophysiol Rev 6(1–2):96–99Google Scholar
  5. 5.
    Behnia R, Molteni A, Igic R (2003) Angiotensin-converting enzyme inhibitors: mechanisms of action and implications in anesthesia practice. Curr Pharm Des 9(9):763–776CrossRefPubMedGoogle Scholar
  6. 6.
    Benkert O, Hippius H (2005) Kompendium der psychiatrischen Pharmakotherapie. Springer, Berlin Heidelberg New YorkGoogle Scholar
  7. 7.
    Beresford BJ, Glick D, Dinwiddie SH (2004) Combination propofol-alfentanil anesthesia for electroconvulsive therapy in patients receiving monoamine oxidase inhibitors. J ECT 20(2):120–122PubMedGoogle Scholar
  8. 8.
    Berghe G van den (2003) Insulin therapy for the critically ill patient. Clin Cornerstone 5(2):56–63CrossRefPubMedGoogle Scholar
  9. 9.
    Berghe G van den, Wouters P, Weekers F et al. (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345(19):1359–1367PubMedGoogle Scholar
  10. 10.
    Berghe G van den, Wouters PJ, Bouillon R et al. (2003) Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med 31(2):359–366CrossRefPubMedGoogle Scholar
  11. 11.
    Bernard JM, Quintin L, Pinaud M (1990) Clonidine: from the treatment of hypertension to its use in anesthesia. II: Perioperative use. Ann Fr Anesth Reanim 9(5):423–432PubMedGoogle Scholar
  12. 12.
    Blix HS, Viktil KK, Reikvam A et al. (2004) The majority of hospitalised patients have drug-related problems: results from a prospective study in general hospitals. Eur J Clin Pharmacol 60(9):651–658CrossRefPubMedGoogle Scholar
  13. 13.
    Brabant SM, Bertrand M, Eyraud D et al. (1999) The hemodynamic effects of anesthetic induction in vascular surgical patients chronically treated with angiotensin II receptor antagonists. Anesth Analg 89(6):1388–1392CrossRefPubMedGoogle Scholar
  14. 14.
    Bruessel T (2003) Co-medications, pre-medication and common diseases in the elderly. Best Pract Res Clin Anaesthesiol 17(2):179–190CrossRefPubMedGoogle Scholar
  15. 15.
    Bruguerolle B (1993) Effects of calcium channel blockers on bupivacaine-induced toxicity. Life Sci 53(21):PL349–353CrossRefPubMedGoogle Scholar
  16. 16.
    Burger W, Chemnitius JM, Kneissl GD et al. (2005) Low-dose aspirin for secondary cardiovascular prevention — cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation — review and meta-analysis. J Intern Med 257(5):399–414CrossRefPubMedGoogle Scholar
  17. 17.
    Comfere T, Sprung J, Kumar MM et al. (2005) Angiotensin system inhibitors in a general surgical population. Anesth Analg 100(3):636–644, table of contentsCrossRefPubMedGoogle Scholar
  18. 18.
    Dolenc TJ, Habl SS, Barnes RD et al. (2004) Electroconvulsive therapy in patients taking monoamine oxidase inhibitors. J ECT 20(4):258–261PubMedGoogle Scholar
  19. 19.
    Dunn AS, Turpie AG (2003) Perioperative management of patients receiving oral anticoagulants: a systematic review. Arch Intern Med 163(8):901–908CrossRefPubMedGoogle Scholar
  20. 20.
    Engelman E, Lipszyc M, Gilbart E et al. (1989) Effects of clonidine on anesthetic drug requirements and hemodynamic response during aortic surgery. Anesthesiology 71(2):178–187PubMedGoogle Scholar
  21. 21.
    Fehr SB, Zalunardo MP, Seifert B et al. (2001) Clonidine decreases propofol requirements during anaesthesia: effect on bispectral index. Br J Anaesth 86(5):627–632CrossRefPubMedGoogle Scholar
  22. 22.
    Fischer SP, Mantin R, Brock-Utne JG (1996) Ketorolac and propofol anesthesia in a patient taking chronic monoamine oxidase inhibitors. J Clin Anesth 8(3):245–247CrossRefPubMedGoogle Scholar
  23. 23.
    Freemantle N, Cleland J, Young P et al. (1999) Beta blockade after myocardial infarction: systematic review and meta regression analysis. BMJ 318(7200):1730–1737PubMedGoogle Scholar
  24. 24.
    Furnary AP, Zerr KJ, Grunkemeier GL et al. (1999) Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg 67(2):352–560; discussion 360–362CrossRefPubMedGoogle Scholar
  25. 25.
    Gogarten W, Aken H van, Büttner J et al. (2003) Rückenmarksnahe Regionalanästhesien und Thromboembolieprophylaxe/antithrombotische Medikation. Anaesthesiol Intensivmed 44:218–230Google Scholar
  26. 26.
    Groeben H (2004) Strategies in the patient with compromised respiratory function. Best Pract Res Clin Anaesthesiol 18(4):579–594CrossRefPubMedGoogle Scholar
  27. 27.
    Hankey GJ, Eikelboom JW (2003) Antiplatelet drugs. Med J Aust 178(11):568–574PubMedGoogle Scholar
  28. 28.
    Herbstreit F, Peters J (2005) Spinal anaesthesia despite combined clopidogrel and aspirin therapy in a patient awaiting lung transplantation: effects of platelet transfusion on clotting tests. Anaesthesia 60(1):85–87CrossRefPubMedGoogle Scholar
  29. 29.
    Horlocker TT, Wedel DJ (1998) Anticoagulation and neuraxial block: historical perspective, anesthetic implications, and risk management. Reg Anesth Pain Med 23(6) [Suppl 2]:129–134Google Scholar
  30. 30.
    Jacob D, Grignon S, Attolini L et al. (1996) Effects of calcium antagonists on binding of local anesthetics to plasma proteins and erythrocytes in mice. Pharmacology 53(4):219–223PubMedGoogle Scholar
  31. 31.
    Jung J, Schreiber JU (2003) Aktuelle Therapie der Herzinsuffizienz. Anaesthesist 52(7):612–618CrossRefPubMedGoogle Scholar
  32. 32.
    Kalenka A, Hinkelbein J (2005) Anästhesie bei Patienten mit Parkinson-Erkrankung. Anaesthesist 54(4):401–409; quiz 410–411CrossRefPubMedGoogle Scholar
  33. 33.
    Katoh T, Ikeda K (1997) The effect of clonidine on sevoflurane requirements for anaesthesia and hypnosis. Anaesthesia 52(4):377–381CrossRefPubMedGoogle Scholar
  34. 34.
    Kienbaum P von, Peters J (2002) Perioperatives Metformin und Laktatazidose. Anaesthesist 51(10):866–867CrossRefPubMedGoogle Scholar
  35. 35.
    Kennedy JM, Rij AM van, Spears GF et al. (2000) Polypharmacy in a general surgical unit and consequences of drug withdrawal. Br J Clin Pharmacol 49(4):353–362CrossRefPubMedGoogle Scholar
  36. 36.
    Kertai MD, Poldermans D, Bax JJ et al. (2003) Cardiac risk and perioperative management. J Cardiovasc Surg 44(3):431–435Google Scholar
  37. 37.
    Kinney MA, Warner ME, Heerden JA van et al. (2000) Perianesthetic risks and outcomes of pheochromocytoma and paraganglioma resection. Anesth Analg 91(5):1118–1123CrossRefPubMedGoogle Scholar
  38. 38.
    Kovich O, Otley CC (2002) Perioperative management of anticoagulants and platelet inhibitors for cutaneous surgery: a survey of current practice. Dermatol Surg 28(6):513–517CrossRefPubMedGoogle Scholar
  39. 39.
    Kovich O, Otley CC (2003) Thrombotic complications related to discontinuation of warfarin and aspirin therapy perioperatively for cutaneous operation. J Am Acad Dermatol 48(2):233–237CrossRefPubMedGoogle Scholar
  40. 40.
    Lawrence C, Sakuntabhai A, Tiling-Grosse S (1994) Effect of aspirin and nonsteroidal antiinflammatory drug therapy on bleeding complications in dermatologic surgical patients. J Am Acad Dermatol 31(6):988–992PubMedGoogle Scholar
  41. 41.
    Ley SC, Preckel B, Schlack W (2005) Perioperative Behandlung von Patienten mit Diabetes mellitus. Anasthesiol Intensivmed Notfallmed Schmerzther 40(4):230–246; quiz 247–249CrossRefPubMedGoogle Scholar
  42. 42.
    Lindenauer PK, Fitzgerald J, Hoople N et al. (2004) The potential preventability of postoperative myocardial infarction: underuse of perioperative beta-adrenergic blockade. Arch Intern Med 164(7):762–766CrossRefPubMedGoogle Scholar
  43. 43.
    Litz RJ, Gottschlich B, Stehr SN (2004) Spinal epidural hematoma after spinal anesthesia in a patient treated with clopidogrel and enoxaparin. Anesthesiology 101(6):1467–1470CrossRefPubMedGoogle Scholar
  44. 44.
    Maier C, Gleim M, Weiss T et al. (2002) Severe bleeding following lumbar sympathetic blockade in two patients under medication with irreversible platelet aggregation inhibitors. Anesthesiology 97(3):740–743CrossRefPubMedGoogle Scholar
  45. 45.
    Mangano DT (1995) Preoperative assessment of the patient with cardiac disease. Curr Opin Cardiol 10(5):530–542PubMedGoogle Scholar
  46. 46.
    Mangano DT (2002) Aspirin and mortality from coronary bypass surgery. N Engl J Med 347(17):1309–1317CrossRefPubMedGoogle Scholar
  47. 47.
    Meersschaert K, Brun L, Gourdin M et al. (2002) Terlipressin-ephedrine versus ephedrine to treat hypotension at the induction of anesthesia in patients chronically treated with angiotensin converting-enzyme inhibitors: a prospective, randomized, double-blinded, crossover study. Anesth Analg 94(4):835–840, table of contentsCrossRefPubMedGoogle Scholar
  48. 48.
    Mercker SK, Maier C, Neumann G et al. (1997) Lactic acidosis as a serious perioperative complication of antidiabetic biguanide medication with metformin. Anesthesiology 87(4):1003–1005CrossRefPubMedGoogle Scholar
  49. 49.
    Moerloose P de, Boehlen F (2002) Two new antithrombotic agents (fondaparinux and ximelagatran) and their implications in anesthesia. Can J Anaesth 49(6):S5–10PubMedGoogle Scholar
  50. 50.
    Nicholson G, Pereira AC, Hall GM (2002) Parkinson’s disease and anaesthesia. Br J Anaesth 89(6):904–916CrossRefPubMedGoogle Scholar
  51. 51.
    Oates HF, Stoker LM, Monaghan JC (1979) Effects of prazosin on blood pressure and plasma renin activity during onset and withdrawal of action in the anaesthetized rat. Clin Exp Pharmacol Physiol 6(3):355–358PubMedGoogle Scholar
  52. 52.
    Pilote L, Beck CA, Karp I et al. (2004) Secondary prevention after acute myocardial infarction in four Canadian provinces, 1997–2000. Can J Cardiol 20(1):61–67PubMedGoogle Scholar
  53. 53.
    Poldermans D, Boersma E, Bax JJ et al. (2001) Bisoprolol reduces cardiac death and myocardial infarction in high-risk patients as long as 2 years after successful major vascular surgery. Eur Heart J 22(15):1353–1358CrossRefPubMedGoogle Scholar
  54. 54.
    Prys-Roberts C, Farndon JR (2002) Efficacy and safety of doxazosin for perioperative management of patients with pheochromocytoma. World J Surg 26(8):1037–1042CrossRefPubMedGoogle Scholar
  55. 55.
    Rich JM, Njo L, Roberts KW et al. (1998) Unusual hypotension and bradycardia in a patient receiving fenfluramine, phentermine, and fluoxetine. Anesthesiology 88(2):529–531CrossRefPubMedGoogle Scholar
  56. 56.
    Robertshaw HJ, McAnulty GR, Hall GH (2004) Strategies for managing the diabetic patient. Best Pract Res Clin Anaesthesiol 18(4):631–643CrossRefPubMedGoogle Scholar
  57. 57.
    Rosencher N (2004) Ximelagatran, a new oral direct thrombin inhibitor, for the prevention of venous thromboembolic events in major elective orthopaedic surgery. Efficacy, safety and anaesthetic considerations. Anaesthesia 59(8):803–810CrossRefPubMedGoogle Scholar
  58. 58.
    Roth A, Angster R, Forst H (1999) Begleitmedikation. Notwendigkeit, Nebenwirkungen und Interaktionen in der perioperativen Phase. Anaesthesist 48(4):267–283CrossRefPubMedGoogle Scholar
  59. 59.
    Ryckwaert F, Colson P (1997) Hemodynamic effects of anesthesia in patients with ischemic heart failure chronically treated with angiotensin-converting enzyme inhibitors. Anesth Analg 84(5):945–949CrossRefPubMedGoogle Scholar
  60. 60.
    Salpeter S, Greyber E, Pasternak G et al. (2003) Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev 2003(2):CD002967Google Scholar
  61. 61.
    Sloan SB, Weitz HH (2001) Postoperative arrhythmias and conduction disorders. Med Clin North Am 85(5):1171–1189CrossRefPubMedGoogle Scholar
  62. 62.
    Smith MS, Muir H, Hall R (1996) Perioperative management of drug therapy, clinical considerations. Drugs 51(2):238–259PubMedGoogle Scholar
  63. 63.
    Soriano SG, Kaus SJ, Sullivan LJ et al. (2000) Onset and duration of action of rocuronium in children receiving chronic anticonvulsant therapy. Paediatr Anaesth 10(2):133–136CrossRefPubMedGoogle Scholar
  64. 64.
    Spyropoulos AC, Frost FJ, Hurley JS et al. (2004) Costs and clinical outcomes associated with low-molecular-weight heparin vs unfractionated heparin for perioperative bridging in patients receiving long-term oral anticoagulant therapy. Chest 125(5):1642–1650CrossRefPubMedGoogle Scholar
  65. 65.
    Steinhubl SR, Berger PB, Mann JT et al. (2002) Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA 288(19):2411–2420CrossRefPubMedGoogle Scholar
  66. 66.
    Stevens RD, Burri H, Tramer MR (2003) Pharmacologic myocardial protection in patients undergoing noncardiac surgery: a quantitative systematic review. Anesth Analg 97(3):623–633CrossRefPubMedGoogle Scholar
  67. 67.
    Timmermans PB, Slothorst-Grisdijk FP, Kemenade JE van et al. (1982) Hypotensive properties of benzodioxane derivatives structurally related to R 28935. Comparison of activity with some receptor affinities. Arch Int Pharmacodyn Ther 255(2):321–334PubMedGoogle Scholar
  68. 68.
    Ure DS, Gillies MA, James KS (2000) Safe use of remifentanil in a patient treated with the monoamine oxidase inhibitor phenelzine. Br J Anaesth 84(3):414–416PubMedGoogle Scholar
  69. 69.
    Wallace JM, Gill DP (1978) Prazosin in the diagnosis and treatment of pheochromocytoma. JAMA 240(25):2752–2753CrossRefPubMedGoogle Scholar
  70. 70.
    Williams NE (1999) Profound bradycardia and hypotension following spinal anaesthesia in a patient receiving an ACE inhibitor: an important „drug“ interaction? Eur J Anaesthesiol 16(11):796–798CrossRefPubMedGoogle Scholar
  71. 71.
    Zimmer R, Gieschke R, Fischbach R et al. (1990) Interaction studies with moclobemide. Acta Psychiatr Scand Suppl 360:84–86PubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2005

Authors and Affiliations

  1. 1.Bundesinstitut für Arzneimittel und MedizinprodukteBonn
  2. 2.Klinik für AnästhesiologieUniversitätsklinikumAachen
  3. 3.Division Perioperative Medicine and Emergency CareUniversity Medical CenterUtrechtThe Netherlands
  4. 4.Division Perioperative and Emergency Care, Department of AnesthesiologyUniversity Medical Center, E.03.511UtrechtThe Netherlands

Personalised recommendations