Zusammenfassung
Grundlagen: Aufgrund der raschen Zunahme des Anteils der älteren Bevölkerung an der Gesamtbevölkerung steigt auch deren medizinischer Versorgungsbedarf. Chronologisches Alter per se bedeutet heute allerdings keine Kontraindikation mehr für die Durchführung eines diagnostisch-interventionellen oder operativen Eingriffes.
Methodik: Zunächst ist es wichtig, zwischen dem chronologischen und dem wesentlich aussagekräftigeren, biologischen Alter eines Patienten zu unterscheiden. Die wenigen bis dato vorliegenden Untersuchungen zeigen, dass sämtliche Organsysteme einem Alterungsprozess unterworfen sind. Meist reicht die Funktion der Organsysteme eines alten Menschen aus, um den Anforderungen des Alltags gerecht zu werden, die funktionelle Leistungsreserve ist aber oft eingeschränkt, was in Ausnahmesituationen relevant werden kann. Im Falle einer geplanten Operation ist es dann daher wichtig, die funktionelle Leistungsreserve zu evaluieren. Darauf basierend wird ein perioperatives Behandlungskonzept erarbeitet, das durch präoperative Verbesserung der Ausgangslage (Stoffwechsel, Hämodynamik) und individueller, präziser Betreuung reversible und irreversible Defizite verhindern hilft.
Ergebnisse: Die gewaltigen apparativ-technischen und pharmakologischen Fortschritte der letzten Jahre haben allgemeinund regionalanästhesiologische Verfahren noch besser steuerbar und damit sicherer gemacht. Mittels nicht-invasiven und invasiven Verfahren können Störungen in Organsystemen schon früh entdeckt und folgerichtig therapiert werden. Um ein perfektes perioperatives Gesamtergebnis zu erzielen, ist die volle Ausnützung der Möglichkeiten der postoperativen Schmerztherapie ebenso wichtig wie die Sicherstellung einer letztlich ganzheitsmedizinischen Intensivtherapie, deren Bedarf in den nächsten Jahren sicherlich noch steigen wird.
Schlussfolgerungen: Somit ist konzeptionell immer davon auszugehen, dass der geriatrische Patient nicht einfach ein alter Mensch ist, sondern zu einer vollkommen eigenständigen Patientengruppe mit eigenen physiologischen und pharmakodynamischen Gesetzmäßigkeiten gehört.
Summary
Background: With the background of an increasing number of elderly people, their need of medical support gains more and more importance. However, chronological age per se is no longer a contraindication for performing diagnostic-interventional or surgical procedures.
Methods: With this in mind, it is of interest to differentiate between the chronological and the much more useful, biological age of a patient. The published data indicate that ageing influences each organ in its function. In most cases, the individual organs cope with the requirements of daily life. Nevertheless, there is a reduction of functional organ reserve which may become clinically significant in an exceptional situation like an operation. Therefore, in case of an elective surgical procedure, it is necessary to evaluate this functional reserve. Based on this information, a perioperative treatment plan is to be designed which helps to prevent reversible or irreversible deficits by improving both the preoperative status (e. g. hemodynamic and respiratory condition, metabolism) and the individual intraoperative treatment and postoperative care of the patient.
Results: As a result of the respective technical and pharmacological developments in the course of the last two decades, general and regional anesthesia has become more goal directed, better controllable and, therefore, more secure. Thus, by the use of both non-invasive and invasive monitoring devices disturbances within any organ can be detected to enable early and consequent therapeutic measures. In order to obtain a perfect perioperative result, the postoperative treatment plan has also to include all aspects of modern pain therapy and intensive care, if necessary. For the latter an increasing demand is to be expected over the subsequent years.
Conclusions: In summary, the geriatric population does not consist simply of older patients, but rather represents itself as an entity with its own physiologic and pharmacodynamic principles.
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Gonano, C., Kettner, S.C., Seibt, F.A. et al. Der geriatrische Patient aus chirurgischer Sicht — Perioperative Aspekte. Acta Chir. Austriaca 33, 218–222 (2001). https://doi.org/10.1007/BF02950328
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DOI: https://doi.org/10.1007/BF02950328
Schlüsselwörter
- Anästhesie
- Altern
- Pharmakologie
- Monitoring
- intraoperativ
- perioperative Komplikationen/Prävention und Kontrolle