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Der Anaesthesist

, Volume 68, Issue 4, pp 245–258 | Cite as

Nichtkardiale Eingriffe bei Erwachsenen mit angeborenen Herzfehlern

Wichtigste Parameter des anästhesiologischen Managements
  • C. Massoth
  • A. Zarbock
  • M. WenkEmail author
CME
  • 483 Downloads

Zusammenfassung

Hintergrund

Erwachsene mit angeborenen Herzfehlern (EMAH) stellen einen wachsenden Anteil der Patienten mit nichtkardialen Operationen.

Ziel der Arbeit

Identifizierung der wichtigsten Parameter des anästhesiologischen Managements.

Material und Methoden

Auswertung und Diskussion der Ergebnisse aktueller Originalien und der gegenwärtigen Leitlinienempfehlungen.

Ergebnisse

In Deutschland leben ca. 300.000 EMAH-Patienten. Die präoperative Evaluation ist eine wichtige Einflussgröße perioperativer Morbidität und Mortalität. Die Echokardiographie als wichtigstes diagnostisches Instrument hilft bei der Identifizierung komplikationsassoziierter Befunde. Die Einteilung in Defekte mit Links-rechts-Shunt, obstruktive Vitien und komplexe Defekte vereinfacht die pathophysiologische Zuordnung.

Schlussfolgerungen

Entscheidend für das perioperative Outcome von EMAH-Patienten sind die Identifizierung von Hochrisikopatienten, das Verständnis des individuellen pathophysiologischen Befundes und der intraoperative Erhalt des Herzzeitvolumens.

Schlüsselwörter

Risikoeinschätzung Echokardiographie  Hämodynamik Shunt Obstruktion 

Non-cardiac surgery in adults with congenital heart defects

Most important parameters in anesthesia management

Abstract

Background

Adults with congenital heart disease (CHD) represent an increasing proportion of patients undergoing non-cardiac surgery.

Objective

To identify the most important parameters for management of anesthesia.

Material and methods

Evaluation and discussion of the current original research and guideline recommendations.

Results

There are approximately 300,000 patients with CHD living in Germany. The preoperative evaluation is an important influencing factor affecting perioperative morbidity and mortality. Echocardiography is the key instrument for identifying cardiac conditions predisposing to adverse events. The subdivision of CHD into lesions with left-to-right shunt, obstructive lesions and complex congenital heart diseases facilitates the classification of the pathophysiology.

Conclusion

Decisive for the perioperative outcome of patients with CHD are the identification of high-risk patients, understanding of the individual situation with respect to the underlying pathophysiology and the intraoperative maintenance of cardiac output.

Keywords

Risk assessment Echocardiography Hemodynamics Shunt Obstruction 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

Gemäß der Richtlinien des Springer Medizin Verlags werden Autoren und Wissenschaftliche Leitung im Rahmen der Manuskripterstellung und Manuskriptfreigabe aufgefordert, eine vollständige Erklärung zu ihren finanziellen und nichtfinanziellen Interessen abzugeben.

Autoren

C. Massoth gibt an, dass kein finanzieller Interessenkonflikt besteht. Nichtfinanzielle Interessen: Assistenzärztin der Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie der Universitätsklinik Münster | Mitgliedschaften bei der DGAI und der ESA. A. Zarbock gibt an, Forschungsförderung von folgenden Firmen/Institutionen erhalten zu haben: GIF, BMBF, DFG, Astellas, Fresenius, Astute Medical sowie Honorare/Kostenerstattung von folgenden Firmen: Baxter, bioMerieux, Fresenius, Astute Medical, Ratiopharm, Amomed. Er ist bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger o.Ä. gewesen für/von: Springer, A&A, Astellas, bioMerieux, Astute Medical. Nichtfinanzielle Interessen: DGAI, ESA, IARS, DAAF. M. Wenk gibt an, dass kein Interessenkonflikt besteht.

Wissenschaftliche Leitung

Die vollständige Erklärung zum Interessenkonflikt der Wissenschaftlichen Leitung finden Sie am Kurs der zertifizierten Fortbildung auf www.springermedizin.de/cme.

Der Verlag

erklärt, dass für die Publikation dieser CME-Fortbildung keine Sponsorengelder an den Verlag fließen.

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 2019

Authors and Affiliations

  1. 1.Klinik für Anästhesiologie, operative Intensivmedizin und SchmerztherapieUniversitätsklinikum MünsterMünsterDeutschland

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