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Der Anaesthesist

, Volume 61, Issue 8, pp 691–695 | Cite as

Modifizierte Blitzintubation im Kreißsaal

Fallserie zum Einsatz von Rocuronium und Sugammadex
  • D. NauheimerEmail author
  • C. Kollath
  • G. Geldner
Kasuistiken

Zusammenfassung

Hintergrund

Die bronchopulmonale Aspiration ist eine weit gefürchtete Komplikation in der Anästhesie. Ihre Inzidenz wird mit etwa 0,3–1% angegeben, und sie geht mit deutlich erhöhter Morbidität sowie Mortalität einher (Beck-Schimmer u. Bonvini, Eur J Anaesthesiol 2011, 28:78–84). Die „rapid sequence induction“ (RSI, Notfalleinleitung) stellt das Verfahren der Wahl zur Narkoseeinleitung des aspirationsgefährdeten Patienten dar. Seit mittlerweile über 50 Jahren gilt bei der RSI Succinylcholin aufgrund seiner kurzen Anschlagszeit und kurzer Wirkdauer als Relaxans der Wahl. Im Hinblick auf das ausgeprägte Nebenwirkungsprofil von Succinylcholin wurde versucht, besser geeignete, alternative Relaxanzien, wie beispielsweise Rocuronium zur RSI einzusetzen.

Material und Methode

In einer kleinen Fallserie wurde im Rahmen von Sectiones im Kreißsaal bei 10 Schwangeren ein modifiziertes RSI-Protokoll verwendet. Dieses beinhaltete zur Einleitung der Muskelrelaxation die Gabe von 1,0 mg/kgKG Rocuronium und die Aufrechterhaltung einer tiefen Relaxierung bis zum Ende der Operation. Zur Reversierung der neuromuskulären Blockade nach Beendigung der Hautnaht wurde das µ-Zyklodextrin Sugammadex, in einer Dosierung abhängig von der Tiefe der neuromuskulären Restblockade, appliziert. Neben den Intubationsbedingungen nach 60 s wurden Nebenwirkungen wie Herzrhythmusstörungen, Heiserkeit, anaphylaktische Reaktionen, postoperative Übelkeit und Erbrechen postoperativ, nach 24 und 48 h erfragt sowie dokumentiert.

Schlussfolgerungen

Die Kombination von Rocuronium und Sugammadex zur RSI im Rahmen von Sectiones im Kreißsaal vereint neben den Vorteilen der nichtdepolarisierenden Eigenschaften des Rocuroniums schnelle Anschlagszeiten, sehr gute Intubationsbedingungen und die rasche Reversierung durch Sugammadex am Operationsende. Schwerwiegende Nebenwirkungen wurden nicht beobachtet. Heiserkeit sowie Halsschmerzen beklagten 30% und Muskelschmerzen 10% der untersuchten Frauen bis 48 h nach dem Eingriff.

Schlüsselwörter

Sectio Caesarea Nichtdepolarisierende Muskelrelaxanzien Neuromuskuläre Blockade Gastrische Aspiration Fetus 

Modified rapid sequence induction for Caesarian sections

Case series on the use of rocuronium and sugammadex

Abstract

Background

Aspiration is a feared complication of anesthesia and is accompanied by increased morbidity and mortality. Rapid sequence induction (RSI) describes the preferred procedure to perform endotracheal placement of the tubus in emergency cases of patients with an increased risk of aspiration of gastric contents. For more than 50 years RSI has consisted of the application of suxamethonium for neuromuscular blockade because of its fast onset and ultra short duration. Due to the serious side effects of suxamethonium attempts were made to find better alternative neuromuscular blocking drugs, e.g. rocuronium, to perform RSI.

Materials and methods

In this small clinical series RSI was performed for general anesthesia of ten pregnant women for Caesarean sections using 1.0 mg/kgBW rocuronium for induction and maintaining deep relaxation until the end of surgery. For rapid reversal of the neuromuscular blockade to a train-of-four (TOF) ratio of 0.9, the µ-cyclodextrin sugammadex was administered at the end of surgery. Major and minor side effects, such as cardiac dysrhythmia, anaphylactic reactions, hoarseness and postoperative nausea and vomiting were documented.

Conclusions

The combination of rocuronium and sugammadex for RSI combines rapid onset and rapid reversal of neuromuscular blockades with avoidance of serious side effects and very comfortable conditions for intubation in all cases. Minor side effects such as hoarseness, throat discomfort (in up to 30%) and myalgia (10%) for up to 48 h were documented.

Keywords

Caesarean section Neuromuscular nondepolarizing agents Neuromuscular blockade Gastric aspiration Fetus 

Notes

Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehung hin: Professor Geldner hat Honorare bezogen für Vorträge von: MSD und GSK.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Abteilung für Anästhesiologie, Intensiv- und NotfallmedizinKrankenhaus der Barmherzigen BrüderTrierDeutschland
  2. 2.Abteilung für Anästhesiologie, Intensivmedizin, Notfallmedizin und SchmerztherapieKlinikum LudwigsburgLudwigsburgDeutschland

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