Zusammenfassung
In der anästhesiologischen und intensivmedizinischen Praxis werden in zunehmendem Maß auch Patienten mit implantierten Medikamentenpumpen behandelt. Grundkenntnisse über die Besonderheiten dieser Therapiemethode sind deshalb wichtig. Im Rahmen der präanästhesiologischen Visite müssen Informationen über die Pumpe, den intrathekalen Katheter, Art und Dosierung der applizierten Medikamente sowie der nächste Befülltermin erfragt und dokumentiert werden. Punktionen im Bereich der Pumpe und des Katheterverlaufs müssen vermieden werden. Im Rahmen der intensivmedizinischen Betreuung müssen Wechselwirkungen sowie Über- oder Unterdosierungen der intrathekal verabreichten Medikamente bedacht werden. Die Kenntnis der Befülltermine und die rechtzeitige Organisation der Befüllung sind wesentlich, um Komplikationen zu vermeiden.
Abstract
In anaesthesiological and intensive care practice patients are inceasingly being treated with implanted medication pumps. Basic knowledge on the special aspects of this form of therapy is therefore important. During the preanasthesiology visit, information on the pump, the intrathecal catheter, type and dosage of the medication as well as the next scheduled refilling must be collected and documented. Needle punctures near the pump and the catheter must be avoided. During intensive care treatment any possible interaction and overdosing or underdosing of the intrathecally administered medication must be considered. Information on the schedule and punctual organisation of refilling are important to avoid complications.
Literatur
Anderson VC, Burchiel KJ (1999) A prospective study of long-term intrathecal morphine in the management of chronic nonmalignant pain. Neurosurgery 44: 289–300
Avellino AM, Loeser JD (2000) Intrathecal baclofen for the treatment of intractable spasticity of spine or brain etiology. Neuromodulation 3: 75–81
Coffey RJ, Edgar TS, Francisco GE et al. (2002) Abrupt withdrawal from intrathecal baclofen: recognition and management of a potentially life-threatening syndrome. Arch Phys Med Rehabil 83: 735–741
Creedon SD, Dijkers MPJM, Hinderer SR (1997) Intrathecal baclofen for severe spasticity: a meta-analysis. Int J Rehab Health 3: 171–185
Darouiche RO (2004) Treatment of infections associated with surgical implants. N Engl J Med 350: 1422–1429
Hassenbusch SJ, Pillay PK, Magdinec M et al. (1990) Constant infusion of morphine for intractable cancer pain using an implanted pump. J Neurosurg 73: 405–409
Kumar K, Hunter G, Demeria DD (2002) Treatment of chronic pain by using intrathecal drug therapy compared with conventional pain therapies: a cost-effectiveness analysis. J Neurosurg 97: 803–810
Lierz P, Tüchy G, Felleiter P (1999) Rückenmarknahe Schmerztherapie. Eine Statuserhebung in Deutschland und Österreich. Schmerz 13: 127–132
Onofrio BM, Yaksh TL (1990) Long-term pain relief produced by intrathecal morphine infusion in 53 patients. J Neurosurg 72: 200–209
Penn RD (1992) Intrathecal baclofen for spasticity of spinal origin: seven years of experience. J Neurosurg 77: 236–240
Plassat R, Verbe BP, Menei P et al. (2004) Treatment of spasticity with intrathecal baclofen administration: long-term follow-up, review of 40 patients. Spinal Cord 42: 686–693
Roberts LJ, Finch PM, Goucke CR, Price LM (2001) Outcome of intrathecal opioids in chronic non-cancer pain. Eur J Pain 5: 353–361
Sampson FC, Hayward A, Evans G et al. (2002) Functional benefits and cost/benefit analysis of continuous intrathecal baclofen infusion for the management of severe spasticity. J Neurosurg 96: 1052–1057
Thompson JC, Dunbar E, Laye RR (2006) Treatment challenges and complications with ziconotide monotherapy in established pump patients. Pain Physician 9: 147–152
Tsuji C, Saito H, Hatano K (1997) Leg pain under spinal anesthesia in leprosy patients. Masui 46: 704–707
Wang JK, Nauss LA, Thomas JE (1979) Pain relief by intrathecally applied morphine in man. Anesthesiology 50: 149–151
Winkelmüller M, Winkelmüller W (1991) Intrathekale Opiattherapie bei chronischen Schmerzsyndromen benigner Ätiologie über implantierbare Medikamentenpumpen. Schmerz 5: 28–36
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Felleiter, P., Lierz, P. Kontinuierliche intrathekale Medikamentenapplikation. Anaesthesist 56, 822–827 (2007). https://doi.org/10.1007/s00101-007-1204-y
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DOI: https://doi.org/10.1007/s00101-007-1204-y