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Anästhesie und Schlaf-Apnoe-Syndrom

Anesthesia and sleep apnea syndrome

  • Allgemeinanästhesie
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Zusammenfassung

Ein Schlaf-Apnoe-Syndrom (SAS) erhöht das Risiko für perioperative Komplikationen bei anästhesierten und sedierten Patienten. Der Anteil an Patienten mittleren Alters mit signifikanten klinischen Symptomen wird bei Männern auf 4%, bei Frauen auf 2% geschätzt. Jedoch sind 80–95% der SAS-Erkrankten nicht diagnostiziert. Zur Identifikation und sicheren perioperativen Betreuung ist ein systematisches Vorgehen zwingend notwendig. Hierbei sollte es sich um ein interdisziplinäres Konzept handeln, das erhöhte Aufmerksamkeit bei dem pflegerischen/ärztlichen Personal, Evaluation der Intubationsverhältnisse, Abklärung kardiopulmonaler Vorerkrankungen, permanente Kontrolle der Atemwege, differenzierten und angepassten Einsatz von Anästhetika sowie konsequentes Monitoring beinhaltet. Der perioperative Einsatz und die Weiterführung einer „Nasal-continuous-positive-airway-pressure- (CPAP-)Therapie“ sowie die postoperative Verlegung in eine entsprechende Überwachungseinheit sind unbedingt zu empfehlen. Insgesamt besteht noch ein erheblicher Bedarf an kontrollierten Studien zum perioperativen Management von SAS-Patienten.

Abstract

The perioperative risk for patients with obstructive sleep apnea syndrome and the optimal anaesthesiological management of these patients have not been well elucidated. The prevalence of obstructive sleep apnea with significant symptoms is estimated to be 4% in men and 2% in women. However, in 80–95% of patients this syndrome is not sufficiently diagnosed. Thus identification of patients at risk and a thorough multidisciplinary diagnostic approach are essential for optimal perioperative management. The risk of perioperative complications, like cardiopulmonary compromise, and difficulties in airway management is elevated. The most important aspects of perioperative management include evaluation of intubating conditions, careful search for cardiopulmonary morbidity, permanent control of patient airways, sensible use of anaesthetics, sedatives, and narcotics, and strict monitoring of vital signs. If ambulatory nasal continuous positive airway pressure (CPAP) therapy has been established preoperatively, this should be continued in the perioperative period. Postoperative monitoring should be performed in an intensive care or intermediate care unit. Controlled clinical studies on the best perioperative management of patients with obstructive sleep apnea are urgently required.

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  1. Abteilung Anaesthesiologie, Intensivmedizin, Schmerztherapie, Universitätsklinikum Gießen

    B. Hartmann,  A. Junger MDA & J. Klasen

  2. Abteilung Anaesthesiologie, Intensivmedizin, Schmerztherapie, Universitätsklinikum Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen

    A. Junger MDA

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Herrn Prof. Dr. Dr. h.c. Gunter Hempelmann, Direktor der Abt. Anaesthesiologie, Intensivmedizin, Schmerztherapie am Universitätsklinikum Gießen, zum 65. Geburtstag gewidmet.

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Hartmann, B., Junger, A. & Klasen, J. Anästhesie und Schlaf-Apnoe-Syndrom. Anaesthesist 54, 684–693 (2005). https://doi.org/10.1007/s00101-005-0841-2

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