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Der Anaesthesist

, Volume 67, Issue 7, pp 480–487 | Cite as

Hybridoperationssaal

  • T. Fuchs-Buder
  • N. Settembre
  • D. Schmartz
Leitthema
  • 900 Downloads

Zusammenfassung

Ein Hybrid-OP ermöglicht es, differenzierte radiologische Diagnostik und minimalinvasive Interventionen mit den Optionen klassischer offener Chirurgie zu kombinieren. Dazu ist ein Hybrid-OP mit einer Angiographieanlage sowie weiteren bildgebenden Großgeräten ausgestattet. Der Standort eines Hybrid-OP befindet sich häufig außerhalb bzw. am Rand des eigentlichen OP-Bereichs. Die Möglichkeit, im gleichen OP sowohl minimalinvasiv, interventionell als auch klassisch offen operieren zu können, führt dazu, dass beide chirurgischen Verfahren zu einem Hybrideingriff kombiniert werden. Typische Einsatzgebiete eines Hybrid-OP sind neben Kardio‑, Thorax- und Gefäßchirurgie auch Neurochirurgie und Neuroradiologie sowie Orthopädie und Traumatologie. Der kathetergestützte Ersatz der Aortenklappe (TAVI) ist ein deutlich weniger invasives Verfahren als der herkömmliche, klassisch-chirurgische Ersatz der Aortenklappe und eignet sich besonders für ältere Patienten jenseits von 75 Jahren mit entsprechend ausgeprägter Komorbidität. Viele gefäßchirurgische Eingriffe, die früher konventionell chirurgisch durchgeführt wurden, können mittlerweile komplett oder teilweise durch endovaskuläre, kathetergestützte Eingriffe versorgt werden. Als besonders vorteilhaft für die endovaskuläre Versorgung von thorakalen oder abdominalen Aneurysmen hat sich die Möglichkeit erwiesen, unter Lokalanästhesie den proximal des Aneurysmas liegenden Teil der Aorta mit einem Dilatationsballon blockieren zu können und so die Blutungsgefahr kontrollieren zu können. Fortschritte in der Bildfusion und intraoperativen Navigation erhöhen zunehmend die Akzeptanz von Hybrid-OP in den Bereichen Orthopädie/Traumatologie. Die komplexe Versorgung von Hochrisikopatienten an einem dezentralen Standort stellt eine besondere Herausforderung an die Anästhesie dar.

Schlüsselwörter

Arbeitsablauf Endovaskuläre Verfahren Transkatheter Aortenklappenersatz Monitoring, intraoperativ Anästhesie 

Hybrid operating theater

Abstract

A hybrid suite is an operating theater with imaging equipment equivalent to that used in an angiography suite with computed tomography (CT) and magnetic resonance imaging (MRI). They are often situated outside the operating room area and typically serve as multifunctional rooms designed to support a variety of catheter-based endovascular procedures and open surgery to be performed in the same location. The possibility to perform these in the same location facilitates the combination of both approaches to so-called hybrid procedures. Typical clinical applications of hybrid suites are cardiac, thoracic and vascular surgery, neurosurgery and neuroradiology, as well as orthopedics and traumatology. Transcatheter aortic valve implantation (TAVI) is significantly less invasive than a classical approach by open surgery. Patients older than 75 years with relevant comorbidities benefit most from the minimally invasive interventional approach. There has been a paradigm shift in the management of vascular diseases from open surgical repair to new percutaneous endovascular interventions with good early outcomes. Of particular interest in this context is the ability to block the part of the aorta proximal to the aneurysm with a catheter-based dilatation balloon. Progress in image fusion technology and intraoperative navigation has led to an increased acceptance of hybrid suites in orthopedics and traumatology. The complex care of high-risk patients most often outside the operating theater area is a challenge for the anesthesia team. This demands meticulous planning on behalf of the anesthesiologist to ensure an appropriate and safe strategy for anesthesia, intraoperative monitoring, vascular access and the need for additional equipment. A thorough understanding of the complexity of procedures is vital and a series of questions must be addressed: what is needed to safely administer anesthesia in this environment? What additional resources would be needed for an emergency situation? Is the patient being kept safe from radiation hazards? Moreover, logistics may become an issue as the hybrid suite is most often delocalized. In addition, many procedures realized in a hybrid suite require a multidisciplinary approach and therefore teamwork and professional communication are mandatory. Anesthesiologists need to have an integral role in the hybrid suite team, understanding and anticipating the risks for patients and leading the organization of workflow. The challenge in anesthesia is to ensure that when patients are taken to these complex environments the resources available enable high standards of care to be provided. With future developments in imaging technology combined with more powerful hardware and software, a far greater integration of all these imaging and navigation technologies will be seen in future operating rooms. Finally, patients are becoming more aware of medical developments via the world wide web and increasingly request what they consider to be state of the art treatment.

Keywords

Workflow Endovascular procedures Transcatheter aortic valve replacement Monitoring, intraoperative Anesthesia 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

T. Fuchs-Buder, N. Settembre und D. Schmartz geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Anästhesie und IntensivmedizinUniversitätsklinikum NancyNancyFrankreich
  2. 2.Klinik für GefäßchirurgieUniversitätsklinikum NancyNancyFrankreich
  3. 3.Klinik für AnästhesieUniversitätsklinikum BrugmannBrüsselBelgien
  4. 4.Département d’Anesthésie-RéanimationVandoeuvre-les-NancyFrankreich

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