Gefässchirurgie

, Volume 18, Issue 1, pp 28–34

Anästhesiologische Aspekte in der Gefäßmedizin

Leitthema

Zusammenfassung

Gefäßchirurgische Patienten erfordern eine besondere perioperative Betreuung durch alle beteiligten Fachdisziplinen, weil die Gefäßveränderungen nur selten isoliert auftreten. Patienten mit einer pAVK weisen typische Merkmale und Begleiterkrankungen auf wie Hypercholesterinämie, arterieller Hypertonus, Diabetes mellitus, langjähriger inhalativer Tabakkonsum, männliches Geschlecht und eine positive Familienanamnese. Schlaganfall, Herzinfarkt sowie Durchblutungsstörungen der Beine und der Nieren sind Auswirkungen einer systemischen Gefäßerkrankung und haben damit einen direkten Einfluss auf das perioperative Risiko. Der gefäßchirurgische Patient ist deshalb häufig ein Patient mit erhöhtem Risiko und stellt an die perioperative Versorgung besondere Ansprüche. Der Anästhesist benötigt fundierte pathophysiologische Kenntnisse zu den jeweiligen Begleiterkrankungen, deren spezifischen Risiken und deren möglichen perioperativen Behandlungsoptionen.

Schlüsselwörter

Anästhesie Diabetische Angiopathie Chirurgie Gefäßchirurgische Eingriffe Methoden 

Anaesthetic aspects in vascular medicine

Abstract

The vascular surgical patient is often a patient at increased risk and provides special perioperative care and requirements. Patients with peripheral arterial occlusive disease have concomitant diseases and characteristics such as hypercholesterolemia, hypertension, diabetes mellitus, longterm inhaled tobacco use, a male gender and a positive family history. Former cerebral ischaemia, heart attack and blood circulation problems in the legs and kidneys have a direct impact on the perioperative morbidity. For risk optimization the anaesthetist should have high theoretical and practical experience in the used anaesthetic techniques and a profound knowlege of the pathophysiological characteristics of the vascular procedures.

Keywords

Anaesthesia Diabetic angiopathies Surgery Vascular surgical procedures Methods 

Literatur

  1. 1.
    Diehm C, Weiss T (2000) AVK-Fibel. 3 Aufl. Lingua Med-Verlag, Neu-IsenburgGoogle Scholar
  2. 2.
    Diehm C, Schuster A, Allenberg H et al (2004) High prevalence of peripheral arterial disease and co-morbidity in 6,880 primary care patients: cross sectional study. Atherosclerosis 172:95–105PubMedCrossRefGoogle Scholar
  3. 3.
    Willigendael EM, Teijink JA, Bartelink ML et al (2004) Influence of smoking on incidence and prevalence of peripheral arterial disease. J Vasc Surg 40(6):1158–1165PubMedCrossRefGoogle Scholar
  4. 4.
    (o A) (2010) Präoperative Evaluation erwachsener Patienten vor elektiven, nicht kardiochirurgischen Eingriffen. Anästh Intensivmed 11:788–796Google Scholar
  5. 5.
    Badner NH, Knill RL, Brown JE et al (1998) Myocardial infarction after non-cardiac surgery. Anesthesiology 88:572–578PubMedCrossRefGoogle Scholar
  6. 6.
    King SB IIIrd, Smith SC Jr, Hirshfeld J et al (2008) Focused update of the ACC/AHA/SCAI 2005 Guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice guidelines. Circulation 117(2):261–295PubMedCrossRefGoogle Scholar
  7. 7.
    Nijjer SS, Davies JE, Francis DP (2012) Quantitative comparison of clopidogrel 600 mg, prasugrel and ticagrelor, against clopidogrel 300 mg on major adverse cardiovascular events and bleeding in coronary stenting: synthesis of CURRENT-OASIS-7, TRITON-TIMI-38 and PLATO. Int J Cardiol 158(2):181–185PubMedCrossRefGoogle Scholar
  8. 8.
    Kozek-Langenecker SA, Duris M, Rottmann B (2007) Antikoagulantien und deren Reversierung. Anästh Intensivmed 48:153Google Scholar
  9. 9.
    Sibbing D, Morath T, Stegherr J et al (2009) Impact of proton pump inhibitors on the antiplatelet effects of clopidogrel. Thromb Haemost 101:714–719PubMedGoogle Scholar
  10. 10.
    Bhatt DL, Cryer BL, Contant CF et al (2010) Clopidogrel with or without omeprazole in coronary artery disease. N Engl J Med 363:1909–1917PubMedCrossRefGoogle Scholar
  11. 11.
    Hirsch AT, Treat-Jacobson D, Lando HA et al (1997) The role of tobacco cessation, antiplatelet and lipid-lowering therapies in the treatment of peripheral arterial disease. Vasc Med 2(3):243–251PubMedGoogle Scholar
  12. 12.
    Nair U, Thielmann HW, Pötschke-Langer M (2009) Krebserzeugende Substanzen im Tabakrauch. Deutsches Krebsforschungszentrum, Heidelberg. http://www.tabakkontrolle.deGoogle Scholar
  13. 13.
    Tang CS, Fan SZ, Chan CC (2001) Smoking status and body size increase carbon monoxide concentration in the breathing circuit during low-flow-anesthesia. Anesth Analg 92:542–547PubMedCrossRefGoogle Scholar
  14. 14.
    Warner MA, Offord KP, Warner ME et al (1989) Role of preoperative cessation of smoking and other factors in postoperative pulmonary complications: a blinded prospective study of coronary artery bypass patient. Mayo Clin Proc 64(6):609–616PubMedCrossRefGoogle Scholar
  15. 15.
    Sorensen LT, Hemmingsen U, Kallehave F et al (2005) Risk factors for tissue and wound complications in gastrointestinal surgery. Ann Surg 241:654–658PubMedCrossRefGoogle Scholar
  16. 16.
    Subramaniam B, Panzica PJ, Novack V et al (2009) Continuous perioperative insulin infusion decreases major cardiovascular events in patients undergoing vascular surgery. Anesthesiology 110:970–977PubMedCrossRefGoogle Scholar
  17. 17.
    Berghe G van den, Wouters P, Weekers F et al (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345:1359–1367PubMedCrossRefGoogle Scholar
  18. 18.
    Griesdale DE, Souza RJ de, Dam RM van et al (2009) Intensive insulin therapy and mortality among critically ill patients: a meta analysis including NICE-SUGAR study data. CMAJ 180:821–827PubMedGoogle Scholar
  19. 19.
    Finfer S, Chittock DR, Su SY et al (2009) The NICE-SUGAR Study Investigators: intensive versus conventional glucose control in critically ill patients. N Engl J Med 360:1283–1297PubMedCrossRefGoogle Scholar
  20. 20.
    Adler GK, Bonyhay I, Failing H et al (2009) Antecedent hypoglycemia impairs autonomic cardiovascular function: implications for rigorous glycemic control. Diabetes 58(2):360–366PubMedCrossRefGoogle Scholar
  21. 21.
    American Diabetes Association (2005) Standards of medical care in diabetes. Diabetes Care 28(1):4–36CrossRefGoogle Scholar
  22. 22.
    Williams TM, Harken AH (2008) Statins for surgical patients. Ann Surg 247:30–37PubMedCrossRefGoogle Scholar
  23. 23.
    Mehler PS, Coll JR, Estacio R et al (2003) Intensive blood pressure control reduces the risk of cardiovascular events in patients with peripheral arterial disease and type 2 diabetes. Circulation 107(5):753–756PubMedCrossRefGoogle Scholar
  24. 24.
    Hoeks SE, Scholte OP, Reimer WJ et al (2007) Increase of 1-year mortality after perioperative beta-blocker withdrawal in endovascular and vascular surgery patients. Eur J Vasc Endovasc Surg 33(1):13–19PubMedCrossRefGoogle Scholar
  25. 25.
    Devereaux PJ, Yang H, Yusuf S et al (2008) Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 371:1839–1847PubMedCrossRefGoogle Scholar
  26. 26.
    Barrett BJ, Parfrey PS (2006) Clinical practice. Preventing nephropathy induced by contrast medium. N Engl J Med 354(4):379–386PubMedCrossRefGoogle Scholar
  27. 27.
    Kshirsagar AV, Poole C, Mottl A et al (2004) N-acetylcysteine for the prevention of radiocontrast induced nephropathy: a meta-analysis of prospective controlled trials. J Am Soc Nephrol 15:761–769PubMedCrossRefGoogle Scholar
  28. 28.
    Barrett BJ, Parfrey PS (2006) Preventing nephropathy induced by contrast medium. N Engl J Med 354:379–386PubMedCrossRefGoogle Scholar
  29. 29.
    Frank SM, Higgins MS, Breslow MJ et al (1995) The catecholamine, cortisol and hemodynamic responses to mild perioperative hypothermia: a randomized clinical trial. Anesthesiology 82:83–93PubMedCrossRefGoogle Scholar
  30. 30.
    Frank SM, Fleisher LA, Breslow MJ et al (1997) Perioperative maintenance of normothermia reduces the incidence morbid cardiac events: a randomized clinical trial. JAMA 277:1127–1134PubMedCrossRefGoogle Scholar
  31. 31.
    Kurz A, Sessler DI, Lenhardt R (1996) Perioperative normothermia to reduce the incidence of surgical wound infection and shorten hospitalization. N Engl J Med 334:1209–1215PubMedCrossRefGoogle Scholar
  32. 32.
    Ng SF, Oo CS, Loh KH et al (2003) A comparative study of three warming interventions to determine the most effective in maintaining perioperative normothermia. Anesth Analg 96:171–176PubMedGoogle Scholar
  33. 33.
    Gauss A, Jahn SK, Eberhart LH et al (2011) Kardioprotektion durch thorakale Periduralanästhesie? Anaesthesist 60(10):950–962PubMedCrossRefGoogle Scholar
  34. 34.
    Pöpping DM, Zahn PK, Van Aken HK et al (2008) Effectiveness and safety of postoperative pain management: a survey of 18,925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data. Br J Anaesth 101(6):832–840PubMedCrossRefGoogle Scholar
  35. 35.
    Gogarten W, Van Aken H, Büttner J et al (2007) Rückenmarksnahe Regionalanästhesien und Thromboembolieprophylaxe/antithrombotische Medikation. Anästh Intensivmed 48:109–124Google Scholar
  36. 36.
    Rerkasem K, Rothwell PM (2009) Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). Cochrane Database Syst Rev 7(4):CD000190Google Scholar
  37. 37.
    Rerkasem K, Rothwell PM (2008) Local versus general anaesthesia for carotid endarterectomy. Cochrane Database Syst Rev 8(4):CD000126Google Scholar
  38. 38.
    Gelman S (1995) The pathophysiology of aortic cross-clamping and unclamping. Anesthesiology 82:1026–1057PubMedCrossRefGoogle Scholar
  39. 39.
    Liason JL, Wainess RM, Proctor MC et al (2003) A national and single institutional experience in the contemporary treatment of acute lower extremity ischemia. Ann Surg 238:382–390Google Scholar
  40. 40.
    Sheridan GW, Matsen FA (1976) Fasciotomy in the treatment of the acute compartment syndrome. J Bone Joint Surg 58(1):112–115PubMedGoogle Scholar
  41. 41.
    Diener HC, Maier C (2009) Die Schmerztherapie, 3 Aufl. Elsevier, MünchenGoogle Scholar
  42. 42.
    Hatzenbühler M, Fresenius M, Heck M (2007) Repetitorium Schmerzmedizin, 2 Aufl. Springer Verlag, Berlin Heidelberg New York TokioGoogle Scholar
  43. 43.
    Halbert J, Crotty M, Cameron ID (2002) Evidence for the optimal management of acute and chronic phantom pain: a systematic review. Clin J Pain 18:84–92PubMedCrossRefGoogle Scholar
  44. 44.
    (o A) (2008) Therapie neuropathischer Schmerzen. Leitlinien für Diagnostik und Therapie in der Neurologie, 4 überarbeitete Aufl., Thieme, Stuttgart, S 654 ffGoogle Scholar
  45. 45.
    (o A) (2009) S3-Leitlinie: Behandlung akuter perioperativer und posttraumatischer Schmerzen 2009, Deutsche Interdisziplinäre Vereinigung für Schmerztherapie. http://www.awmf.de (AWMF-Register Nr. 041/001)Google Scholar
  46. 46.
    Dertwinkel R, Heinrichs C, Senne I et al (2001) Prevention of severe phantom limb pain by perioperative administration of ketamine: an observational study. Acute Pain 4:12–16Google Scholar
  47. 47.
    Wilson JA, Nimmo AF, Fleetwood-Walker SM, Colvin LA (2008) A randomised blind trial of the effect of pre-emptive epidural ketamine on persistent pain after lower limb amputation. Pain 135:108–118PubMedCrossRefGoogle Scholar
  48. 48.
    Jaeger H, Maier C (1992) Calcitonin in phantom limb pain: a double-blind study. Pain 48:21–27PubMedCrossRefGoogle Scholar
  49. 49.
    Wall GC, Heyneman CA (1999) Calcitonin in phantom limb pain. Ann Pharmacother 33:499–501PubMedCrossRefGoogle Scholar
  50. 50.
    Ahn C, Mulligan P, Salcido RS (2008) Smoking – the bane of wound healing: biomedical interventions and social influences. Adv Skin Wound Care 21:227–236PubMedCrossRefGoogle Scholar
  51. 51.
    Guo S, Dipietro LA (2010) Factors affecting wound healing. J Dent Res 89:219–229PubMedCrossRefGoogle Scholar
  52. 52.
    Zwissler B, Geldner G, Mertens E et al (2010) Präoperative Evaluation erwachsener Patienten vor elektiven, nichtkardiochirurgischen Eingriffen. Anaesthesist 59(11):1041–1050CrossRefGoogle Scholar
  53. 53.
    (o A) (2008) Jusletter BDAkutell März 2008 Jahrgang 8, Ausgabe 1Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Abteilung für Anästhesiologie, Intensivmedizin, Notfallmedizin, SchmerztherapieAsklepios Klinik HarburgHamburgDeutschland

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