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Anästhesiologisches Management bei endovaskulären Gefäßeingriffen

Management of anesthesia in endovascular interventions

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Zusammenfassung

Die Gefäßerkrankungen stellen eine der wichtigsten Ursachen für die Morbidität und die Letalität in Deutschland dar. Aufgrund des erhöhten Risikoprofils erfordert die Behandlung der betroffenen Patienten ein interdisziplinäres und multimodales Therapiekonzept. In den vergangenen Jahren haben sich endovaskuläre Gefäßeingriffe fest innerhalb dieses Konzepts etabliert. Die unterschiedlichen anatomischen Lokalisationen pathologischer Gefäßveränderungen machen jedoch die Anwendung verschiedenster endovaskulärer Therapieverfahren notwendig. Dementsprechend variieren auch die Anforderungen an das anästhesiologische Management und verlangen ein differenziertes Vorgehen. Endovaskuläre Gefäßeingriffe können sowohl in Regional- (RA) als auch in Allgemeinanästhesie durchgeführt werden. Die gegenwärtig existierenden Untersuchungen zeigen jedoch keine entscheidenden Vorteile im Hinblick auf Letalität und Morbidität durch Anwendung der RA. Allerdings konnte für einige endovaskuläre Eingriffe die Reduktion pulmonaler Komplikationen nachgewiesen werden. Rückenmarknahe RA-Verfahren sollten vor dem Hintergrund der aktuellen Studienlage und der regelhaft vorliegenden Therapie mit Antikoagulanzien, nur nach sorgfältiger Risiko-Nutzen-Abwägung, sowie unter Beachtung der entsprechenden anästhesiologischen Leitlinien angewendet werden. Der vorliegende Beitrag erläutert die anästhesiologischen Besonderheiten anhand einiger ausgewählter endovaskulärer Gefäßeingriffe.

Abstract

Cardiovascular diseases are one of the leading causes of morbidity and mortality in Germany. In these patients, the high-risk profile necessitates an interdisciplinary and multimodal approach to treatment. Endovascular interventions and vascular surgery have become established as an important element of this strategy in the past; however, the different anatomical localizations of pathological vascular alterations make it necessary to use a wide spectrum of procedural options and methods; therefore, the requirements for management of anesthesia are variable and necessitate a differentiated approach. Endovascular procedures can be carried out with the patient under general or regional anesthesia (RA); however, in the currently available literature there is no evidence for an advantage of RA over general anesthesia regarding morbidity and mortality, although a reduction in pulmonary complications could be found for some endovascular interventions. Epidural and spinal RA procedures should be carefully considered with respect to the risk-benefit ratio and consideration of the recent guidelines on anesthesia against the background of the current study situation and the regular use of therapy with anticoagulants. The following article elucidates the specific characteristics of anesthesia management as exemplified by some selected endovascular interventions.

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  1. Klinik für Anästhesiologie und Intensivmedizin, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    T. Rössel, R. Paul, T. Richter, A. R. Heller & T. Koch

  2. Klinik für Viszeral-, Thorax- und Gefäßchirurgie, TU Dresden, Dresden, Deutschland

    S. Ludwig

  3. Institut und Poliklinik für Radiologische Diagnostik, TU Dresden, Dresden, Deutschland

    T. Hofmockel

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Rössel, T., Paul, R., Richter, T. et al. Anästhesiologisches Management bei endovaskulären Gefäßeingriffen. Anaesthesist 65, 891–910 (2016). https://doi.org/10.1007/s00101-016-0241-9

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