Gefässchirurgie

, Volume 18, Issue 1, pp 21–27 | Cite as

Elektive nicht kardiochirurgische Operationen bei Patienten mit kardialer Grunderkrankung

Präoperative Risikoeinschätzung und perioperatives Vorgehen
Leitthema

Zusammenfassung

Das perioperative Risiko einer unerwünschten kardialen Komplikation hängt im Wesentlichen von der präoperativen Konstitution des Patienten, dessen Begleiterkrankungen und der Größe bzw. Länge der geplanten Operation ab.

Um das perioperative kardiale Risiko besser einschätzen zu können und um die perioperative Behandlungsmöglichkeiten und das postoperative Ergebnis zu verbessern, hat die europäische Gesellschaft für Kardiologie in Zusammenarbeit mit der europäischen Gesellschaft für Anästhesiologie im Jahr 2009 neue Leitlinien verfasst. Diese Leitlinien setzen zwei Schwerpunkte: die präoperative Risikoeinschätzung, abgeleitet aus den Begleiterkrankungen des Patienten und aus der Schwere bzw. Länge des geplanten chirurgischen Eingriffes, sowie das perioperative Management in Abhängigkeit von der zuvor festgelegten Risikoeinschätzung.

In Anlehnung an diese Leitlinien gibt dieser Artikel einen kurzen Überblick zu dem Thema, wobei sich insbesondere auf die vorbestehenden kardialen Begleiterkrankungen und das perioperative kardiale Management konzentriert wird.

Schlüsselwörter

Perioperatives Risiko Präoperative Risikoeinschätzung Kardiale Risikofaktoren Nicht kardiochirurgische Operationen Perioperative Behandlung 

Abkürzungen

MET

Metabolic equivalent

TIA

Transistorisch Ischämische Attacke

AICD

Automatic implantable cardioverter defibrillator

LV- Funktion

Linksventrikuläre Funktion

NSTEMI

Nicht ST-Strecken Hebungsinfarkt

BMS

Bare metal Stent

DES

Drug-eluting Stent

PCI

Perkutane koronar Intervention

PTCA

Perkutane transluminale Ballonangioplastie

Elective non-cardiac surgery in patients with underlying cardiac disease

Preoperative risk assessment and perioperative approach

Abstract

The perioperative risk of a cardiac complication is primarily determined by the patient’s preoperative constitution, any existing comorbidities as well as the extent and the duration of the intended surgery. Consequently, the European Society of Cardiology (ESC) endorsed by the European Society of Anaesthesiology (ESA) published guidelines in 2009 aiming at improving perioperative cardiac risk assessment and perioperative treatment as well as the postoperative outcome. In line with these objectives the guidelines mainly focus on two areas: the preoperative risk assessment based on the patients’ comorbidities and the anticipated severity of the intended surgery itself and secondly on the perioperative management derived from the outcome of the previous risk assessment. On the basis of these guidelines this article gives a brief overview on the subject focusing on existing cardiac comorbidities and perioperative cardiac management.

Keywords

Perioperative risk Preoperative risk assessment Clinical risk factors Non-cardiac surgery Perioperative management 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Klinik und Poliklinik für Allgemeine und Interventionelle KardiologieUniversitäres Herzzentrum Hamburg (UHZ), Universitätsklinikum Hamburg-EppendorfHamburgDeutschland
  2. 2.Klinik und Poliklinik für GefäßmedizinUniversitäres Herzzentrum, Universitätsklinikum Hamburg-EppendorfHamburgDeutschland

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