Der Anaesthesist

, Volume 61, Issue 8, pp 678–685 | Cite as

Ist tiefe Narkose gefährlich?

Leitthema

Zusammenfassung

Die Frage nach einer „adäquaten“ Narkosetiefe wurde in den letzten Jahren vorwiegend im Hinblick auf eine zu flache Narkose, also die Vermeidung einer intraoperativen Wachheit mit explizierter Erinnerung, gestellt. Aktuelle Studien thematisieren die Problematik der adäquaten Narkosetiefe von einem gegensätzlichen Standpunkt; sie postulieren, dass die in tiefer Narkose verbrachte Zeit positiv mit einer erhöhten postoperativen Mortalität korreliert. Vier von 5 publizierten Studien konnten einen derartigen Zusammenhang zeigen. Eingeschränkt wird diese Aussage allerdings durch ein suboptimales Studiendesign; so war z. B. in keiner der Studien eine Randomisierung der Teilnehmer erfolgt. Weiterhin ist völlig unklar, ob es sich lediglich um eine Korrelation oder aber um eine kausale Beziehung handelt, d. h., dass die tiefe Narkose die Ursache der erhöhten postoperativen Mortalität ist oder dass nur ein Epiphänomen vorliegt. Von einem Epiphänomen würde man sprechen, wenn z. B. Patienten mit metastasierten Malignomen besonders empfindlich auf Anästhetika reagierten. Solange hierzu keine kontrollierten randomisierten Studien vorliegen, sollten Anästhesisten ihre bisherige Praxis der Narkoseführung beibehalten.

Schlüsselwörter

Allgemeinanästhesie Intraoperative Wachheit Bispektral-Index-Monitor Behandlungs-Outcome Mortalität 

Is deep anesthesia dangerous?

Abstract

Regarding the question of an adequate depth of anesthesia, over the past decade anesthesiologists have focused on the prevention of intraoperative consciousness in combination with explicit memory. Recent studies approached the topic from a different way postulating that deep anesthesia, quantified as time with a bispectral index (BIS)< 45, is associated with increased postoperative mortality and four out of the five published studies revealed such a correlation. However, the finding is limited by a suboptimal study design, e.g. none of the studies presented randomized data. Furthermore, it is ambiguous whether the correlation is causal as the administration of deep anesthesia determines higher postoperative mortality or the study results reveal an epiphenomenon. An epiphenomenon implies e.g. that patients with cancer respond to general anesthesia with deeper cortical depression. In summary, as long as there is a lack of adequately performed randomized trials, there is no reason why anesthesiologists should change the current practice.

Keywords

Anesthesia, general Awareness Bispectral index monitor Treatment outcome Mortality 

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Sektion Experimentelle Anaesthesiologie, Klinik für Anästhesie und IntensivmedizinEberhard-Karls-UniversitätTübingenDeutschland

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