Zusammenfassung
Chronisch obstruktive Lungenerkrankungen [“chronic obstructive pulmonary disease“, (COPD)/Lungenemphysem] sind häufige Krankheitsbilder mit zunehmender Inzidenz und nicht zu unterschätzender medikoökonomischer Bedeutung. Pathophysiologisch liegt eine exspiratorische Obstruktion aufgrund eines gesteigerten Atemwegswiderstands zugrunde. Vor allem die ausgeprägte Komorbidität von COPD-Patienten und die Beeinträchtigung des respiratorischen Systems können die Anästhesie bei Patienten mit COPD erschweren. Die medikamentöse Basis- und eine differenzierte Beatmungstherapie sind in der perioperativen Versorgung von Bedeutung. Dieser Beitrag beinhaltet die derzeit gültigen Empfehlungen der nationalen Versorgungsleitlinie COPD und der „COPD guideline“ der American Thoracic Society.
Abstract
Chronic obstructive pulmonary disease (COPD/pulmonary emphysema) is a common disease with a high incidence and a medico-economical impact which should not be underestimated. Pathophysiologically it is defined as expiratory obstruction due to increased airway resistance. The extensive comorbidity of COPD patients as well as the impairment of the respiratory system make COPD a key challenge for anesthesiologists. Besides basic drug therapy, differentiated ventilation support represents a hallmark of perioperative management. This article includes the current recommendations of the German national care guidelines for COPD as well as the COPD guidelines of the American Thoracic Society.
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Literatur
(2008) Nationale Versorgungsleitlinie COPD – Langfassung Vers. 1.6.; http://www.copd.versorgungsleitlinien.de
Abrishami A, Ho J, Wong J et al (2009) Sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade. Cochrane Database Syst Rev:CD007362
Antonelli M, Pennisi MA, Montini L (2005) Clinical review: noninvasive ventilation in the clinical setting – experience from the past 10 years. Crit Care 9:98–103
Ballantyne JC, Carr DB, de Ferranti S et al (1998) The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg 86:598–612
Bluman LG, Mosca L, Newman N, Simon DG (1998) Preoperative smoking habits and postoperative pulmonary complications. Chest 113:883–889
Carli F, Mayo N, Klubien K et al (2002) Epidural analgesia enhances functional exercise capacity and health-related quality of life after colonic surgery: results of a randomized trial. Anesthesiology 97:540–549
Chappell D, Jacob M, Hofmann-Kiefer K et al (2008) A rational approach to perioperative fluid management. Anesthesiology 109:723–740
Colebourn CL, Barber V, Young JD (2007) Use of helium-oxygen mixture in adult patients presenting with exacerbations of asthma and chronic obstructive pulmonary disease: a systematic review. Anaesthesia 62:34–42
Goff MJ, Arain SR, Ficke DJ et al (2000) Absence of bronchodilation during desflurane anesthesia: a comparison to sevoflurane and thiopental. Anesthesiology 93:404–408
Grocott MP, Mythen MG, Gan TJ (2005) Perioperative fluid management and clinical outcomes in adults. Anesth Analg 100:1093–1106
Licker M, Schweizer A, Ellenberger C et al (2007) Perioperative medical management of patients with COPD. Int J Chronic Obstruct Pulmon Dis 2:493–515
Liu SS, Block BM, Wu CL (2004) Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery: a meta-analysis. Anesthesiology 101:153–161
Rodgers A, Walker N, Schug S et al (2000) Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 321:1493
Schnoor J, Ilgner J, Hein M et al (2009) Perioperative management of patients with obstructive sleep apnoea. Anaesthesist 58:189–198
Similowski T, Agusti A, MacNee W, Schonhofer B (2006) The potential impact of anaemia on chronic disease in COPD. Eur Respir J 27:390–396
Sin DD, Wu L, Man SF (2005) The relationship between reduced lung function and cardiovascular mortality: a population-based study and a systematic review of the literature. Chest 127:1952–1959
Sydow M (2006) Chronisch obstruktive Lungenerkrankungen. In: Wappler F, Tonner PH, Bürkle H (Hrsg) Anästhesie bei Begleiterkrankungen. Springer, Berlin Heidelberg New York Tokio, S 107–119
Winter JH, Buckler PW, Bautista AP et al (1983) Frequency of venous thrombosis in patients with an exacerbation of chronic obstructive lung disease. Thorax 38:605–608
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Spieth, P., Güldner, A. & Gama de Abreu, M. Anästhesie bei Patienten mit chronisch obstruktiven Lungenerkrankungen. Anaesthesist 59, 89–98 (2010). https://doi.org/10.1007/s00101-009-1653-6
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DOI: https://doi.org/10.1007/s00101-009-1653-6