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Perioperatives Patientenmanagement

Evaluation von subjektiver Beanspruchung bei Patientinnen mit elektiven gynäkologischen Operationen

Perioperative patient management

Evaluation of subjective stress and demands of patients undergoing elective gynaecological surgery

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Zusammenfassung

Hintergrund

Ziel dieser Untersuchung war die Evaluation von Beanspruchung und Stress im engen zeitlichen Verlauf während der Vorbereitung zur Allgemeinanästhesie für geplante operative Eingriffe.

Patienten und Methode

In einer prospektiven Untersuchung wurden bei 52 Patientinnen, die für einen operativen gynäkologischen Eingriff in Allgemeinanästhesie vorgesehen waren, hämodynamische (Herzfrequenz und Blutdruck) und endokrine Stressparameter [Kortisolkonzentration in Serum und Speichel sowie Prolaktin und Dehydroepiandrosteronsulfat (DHEA-S) im Serum] bestimmt. Das subjektive Stressempfinden wurde mit dem Kurzantwortbogen zur aktuellen Beanspruchung (KAB) innerhalb kurzer Retestintervalle perioperativ und mit dem ersten Teil des Spielberger-State-Trait-Angstinventars (STAI-X1) prä- und postoperativ beurteilt. Postoperativ wurden alle Patientinnen zur ihrem Urteil über die periprozedurale Qualität und ihren Gesamteindruck während der Narkosevorbereitung befragt.

Ergebnisse

Die subjektiv empfundene Beanspruchung während der Narkosevorbereitung und die präoperativ empfundene Angst ließen sich mit standardisierten Fragebögen einschätzen. Hierbei korrelierte die Selbstauskunft mit der Dignität der Grunderkrankung. Dagegen ließen hämodynamische und endokrine Messparameter keine Rückschlüsse auf das aktuelle Befinden zu. Das postoperative Patientenurteil korrelierte nicht mit dem Verlauf der Beanspruchung.

Schlussfolgerung

In zukünftigen Untersuchungen zum perioperativen Patienten- und Qualitätsmanagement sollten standardisierte Testbögen – anstelle von vegetativen Messparametern allein – zur Evaluation der subjektiven Beanspruchung und des Stressempfindens bei Patienten mit operativen Eingriffen eingesetzt werden.

Abstract

Background

The aim of this investigation was to assess the extent of stress and demands in patients during preparation for general anesthesia for elective surgical procedures.

Patients and methods

A total of 52 female patients scheduled for elective gynecological surgery under general anesthesia were included in this prospective study. The extent and time course of actual demands describing perceived emotional stress was assessed at close intervals using the German version of the Questionnaire for Actual Demands (KAB). Pre-operative and postoperative anxiety was assessed using part one of Spielberger’s state-trait-anxiety inventory (STAI-X1). This was compared to hemodynamic (heart rate und blood pressure) and endocrinal stress parameters [cortisol concentration in serum and saliva, prolactin and dehydroepiandrosteronesulfate (DHEA-S) in serum]. Postoperatively, all patients were asked to rate the quality of care during preparation for general anesthesia.

Results

The extent of patients’ demands and stress during preparation for general anesthesia could be quantified by the short questionnaire for the actual demands (KAB). So-called objective stress parameters like hemodynamic and endocrinal data alone did not correlate with perceived stress. However, the subjective information correlated with the nature of the underlying diagnosis. The postoperative assessment of quality of care during preparation for general anesthesia did not correlate with the course of actual demands and stress.

Conclusion

In future studies assessing the perioperative management of patients and quality of care, standardized testing questionnaires should be preferred, instead of vegetative parameters alone, to reliably evaluate perioperative demands and stress in surgical patients.

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Danksagung

Die Autoren danken Frau Doris Klarner, Leitung Anästhesiepflege OP05, Klinikum der Universität München, Großhadern, und ihrem Team für die Unterstützung bei der Durchführung dieser Untersuchung. Ein Dank gilt allen Mitarbeitern/Innen der Stationen der Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Großhadern.

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Authors and Affiliations

  1. Klinik für Anaesthesiologie, Klinikum der Universität München, München, Deutschland

    B. Gauter-Fleckenstein, R. Kaviani, E. Weninger & U. Kreimeier

  2. Klinik für Anaesthesiologie und operative Intensivmedizin, Klinikum Mannheim, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland

    B. Gauter-Fleckenstein

  3. Abteilung für Biomathematik, Klinikum Mannheim, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland

    C. Weiß

  4. Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe-Großhadern, Klinikum der Universität München, München, Deutschland

    A. Burges

  5. Frauenklinik des Klinikums Duisburg, Wedau Kliniken, Duisburg, Deutschland

    M. Korell

  6. Abteilung für Gynäkologie und Geburtshilfe, Klinikum Starnberg , Starnberg, Deutschland

    C. Anthuber

  7. Institut für Sport und Sportwissenschaft, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland

    H.-D. Hermann

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  1. B. Gauter-Fleckenstein
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Korrespondenzadresse

Dr. B. Gauter-Fleckenstein

Duke University Medical Center

Box 3455

Durham/NC 27701

USA

bhauter@gmx.de

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Gauter-Fleckenstein, B., Kaviani, R., Weiß, C. et al. Perioperatives Patientenmanagement. Anaesthesist 56, 562–570 (2007). https://doi.org/10.1007/s00101-007-1176-y

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