Rückenmarknahe Anästhesie und NOAK

Leitthema

Zusammenfassung

Hintergrund

Kardiovaskuläre Komorbiditäten bei operativen Patienten sind häufig und bestimmen das postoperative Outcome dieser Patienten maßgeblich. Neuroaxiale Blockaden leisten einen wichtigen Beitrag zur Senkung der perioperativen Morbidität und Mortalität. Der steigende Einsatz von neuen direkten oralen Antikoagulanzien (NOAK) erfordert eine besondere Aufmerksamkeit insbesondere bei kardiovaskulär vorerkrankten Patienten, wenn diese eine rückenmarknahe Anästhesie oder postoperative Schmerztherapie erhalten sollen.

Ziel

Ziel des Artikels ist die Darstellung der Bedeutung neuroaxialer Anästhesie- und Analgesieverfahren bei kardiovaskulären Risikopatienten und des Umgangs mit NOAK in diesem speziellen perioperativen Setting.

Material und Methoden

Die Aussagen des vorliegenden Artikels resultieren aus einer Literaturrecherche in PubMed der letzten 25 Jahre sowie der S1-Leitlinie „Rückenmarksnahe Regionalanästhesien und Thromboembolieprophylaxe/antithrombotische Medikation“.

Ergebnisse

Insbesondere die thorakale Epiduralanästhesie und -analgesie trägt beim kardiovaskulären Risikopatienten zu einem verbesserten Outcome bei. Um schwerwiegende Komplikation bei Patienten mit NOAK unter neuroaxialer Blockade zu vermeiden, müssen die S1-Leitlinie der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) beachtet werden und im Einzelfall enge interdisziplinäre Absprachen zwischen Anästhesisten, Kardiologen und Chirurgen stattfinden.

Schlussfolgerung

Unter Beachtung der entsprechenden Leitlinie können kardiovaskuläre Risikopatienten rückenmarknahe Verfahren erhalten, da diese einen essenziellen Beitrag zur Verbesserung des postoperativen Outcomes innerhalb einer erforderlichen interdisziplinären Behandlungsstrategie leisten können.

Schlüsselwörter

Epiduralanästhesie Perioperatives Management Postoperative Phase Kardiovaskuläre Erkrankungen Behandlungsergebnis 

Neuraxial anaesthesia and NOACs

Abstract

Background

Cardiovascular comorbidities in surgical patients are frequent and have a substantial impact on the postoperative outcome. Neuraxial blockades are able to reduce perioperative morbidity and mortality. The increasing use of new oral anticoagulants (NOAC) requires a high level of attention, especially in patients undergoing neuraxial blockades or requiring postoperative analgesia.

Objective

The goal of this article is to present the benefit of neuraxial anaesthesia and analgesia in patients with cardiovascular risks and perioperative management of NOAC in this setting.

Materials and methods

Review of the respective literature in PubMed during the last 25 years as well as presentation of the S1 guideline “Neuraxial anaesthesia and thrombo-embolic prophylaxis/antithrombotic medication” of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI).

Results

Thoracic epidural anaesthesia and analgesia contribute to an improved outcome in surgical patients with high cardiovascular risk. In order to avoid severe complications in patients on NOACs undergoing neuraxial blockades the S1 guideline of the DGAI must be respected and close interdisciplinary consultations between anaesthetist, cardiologist and surgeon are mandatory.

Conclusion

In consideration of the respective guideline neuraxial blockades can be performed in cardiovascular risk patients on NOACs, since these techniques contribute to an improved postoperative outcome.

Keywords

Epidural analgesia Perioperative management Postoperative period Cardiovascular diseases Treatment outcome 

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Copyright information

© Springer Medizin Verlag Berlin 2017

Authors and Affiliations

  1. 1.Klinik für Anästhesie, Operative Intensiv- u. PalliativmedizinStädtisches Klinikum Solingen gGmbHSolingenDeutschland

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