Skip to main content
SpringerLink
Log in

Anästhesieverfahren in Gynäkologie und Geburtshilfe

Ein Blick über das Tuch lohnt sich

Anesthesiological procedures in gynecology and obstetrics

They are worth to sneak a peek at them

  • CME Zertifizierte Fortbildung
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Hintergrund

Nach anästhesiologischer Evaluation sind Allgemein- und Regionalanästhesieverfahren sowie deren Kombination möglich.

Aufklärung

Das Narkosegespräch dient einer rechtsgültigen Aufklärung und der anästhesiologischen Abschätzung des Operationsrisikos.

Vollnarkose

Narkosegase sind heute Etherderivate. Die Verwendung eines Narkosegases in Kombination mit einem Opioid wird balancierte Narkose genannt. Die Verwendung eines i.v.-Sedativums zusammen mit einem Opioid wird als total intravenöse Anästhesie bezeichnet.

Regionalanästhesie

Lokalanästhetika wirken über eine Natriumkanalblockade. Epidurale bzw. spinale Opioidzusätze verbessern das Wirkprofil der Regionalanästhesieverfahren.

Regionalanästhesiekomplikationen

Hämodynamische Komplikationen entstehen vor allem durch eine Sympathikusblockade. 50 % aller epiduralen Hämatome entstehen nach Katheterentfernung.

Fazit für die Praxis

Ein interdisziplinäres Verständnis ist für die Zusammenarbeit zwischen Anästhesie und Gynäkologie/Geburtshilfe essenziell.

Abstract

Background

After anesthesiological evaluation, general anesthesia, regional anesthesia and a combination of both techniques are possible options.

Informed consent

The preanesthesia interview serves as a valid informed consent and preoperative anesthesiological assessment of risk stratification.

General anesthesia

The narcotic gases used nowadays are ether derivatives. The combination of a narcotic gas with an opioid is referred to as a balanced anesthesia. The use of an i.v. sedative with an opioid is defined as total intravenous anesthesia.

Regional anesthesia

Local anesthetics act by a blockade of sodium (Na+) channels. Epidural and spinal introduction of opioids improves the action of regional anesthesia.

Complications in regional anesthesia

Hemodynamic complications are primarily caused by a blockade of the sympathetic nervous system. 50 % of all epidural hematomas appear after catheter removal.

Practical conclusion

Interdisciplinary comprehension of procedures is essential to anesthesiological and gynecological/obstetrical teamwork.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, Deutsche Gesellschaft für Chirurgie, Deutsche Gesellschaft für Innere Medizin (2010) Präoperative Evaluation erwachsener Patienten vor elektiven, nicht kardiochirurgischen Eingriffen. Anasth Intensivmed 51:788–797

    Google Scholar 

  2. Liu LL, Dzankic S, Leung JM (2002) Preoperative electrocardiogram abnormalities do not predict postoperative cardiac complications in geriatric surgical patients. J Am Geriatr Soc 50(7):1186–1191

    Article  PubMed  Google Scholar 

  3. Halm EA, Browner WS, Tubau JF et al (1996) Echocardiography for assessing cardiac risk in patients having noncardiac surgery. Study of Perioperative Ischemia Research Group. Ann Intern Med 125(6):433–441

    Article  CAS  PubMed  Google Scholar 

  4. Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (2008) Diagnostik und Therapie peripartaler Blutungen, S1 Leitlinie. http://www.uni-duesseldorf.de/AWMF/II/015-063.htm. Zugegriffen: 16. Sept. 2014

  5. Girard PDT, Brugger S, Hösli I (2013) Neues aus der geburtshilflichen Anästhesie. Anaesthesist 62(12):963–972

    Article  CAS  PubMed  Google Scholar 

  6. Toledo P (2012) What’s new in obstetric anesthesia: the 2011 Gerard W. Ostheimer lecture. Int J Obstet Anesth 21(1):68–74

    Article  CAS  PubMed  Google Scholar 

  7. Brandt L (1997) Illustrierte Geschichte der Anästhesie. Wissenschaftliche Verlagsgesellschaft, Stuttgart

  8. Rossaint R, Werner C, Zwißler B (2011) Die Anästhesiologie, 3. Aufl. Springer, Heidelberg Berlin New York Tokio

  9. Hempelmann G, Krier C, Schulte am Esch J et al (Hrsg) (2001) Anästhesiologie. Thieme, Stuttgart New York,

  10. Block BM, Liu SS, Rowlingson AJ et al (2003) Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA 290(18):2455–2463

    Article  CAS  PubMed  Google Scholar 

  11. Dolin SJ, Cashman JN, Bland JM (2002) Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth 89(3):409–423

    Article  CAS  PubMed  Google Scholar 

  12. Gerheuser F, Crass D (2005) Spinal anaesthesia. Anaesthesist. 54(12):1245–1267 (quiz 1268–1270)

  13. Kessler P (o J) Update neuraxial anaesthesia and analgesia – less benefit, more risk? Anasth Intensivmed 11:846–860

  14. Zügel N, Bruer C, Breitschaft K, Angster R (2002) Effect of thoracic epidural analgesia on the early postoperative phase after interventions on the gastrointestinal tract. Chirurg 73(3):262–268

    Article  PubMed  Google Scholar 

  15. Fotiadis RJ, Badvie S, Weston MD, Allen-Mersh TG (2004) Epidural analgesia in gastrointestinal surgery. Br J Surg 91(7):828–841

    Article  CAS  PubMed  Google Scholar 

  16. Jørgensen H, Wetterslev J, Møiniche S, Dahl JB (2000) Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database Syst Rev 4:CD001893

    PubMed  Google Scholar 

  17. Kozian A, Schilling T, Hachenberg T (2005) Non-analgetic effects of thoracic epidural anaesthesia. Curr Opin Anaesthesiol 18(1):29–34

    Article  PubMed  Google Scholar 

  18. Riles TS, Fisher FS, Schaefer S et al (1993) Plasma catecholamine concentrations during abdominal aortic aneurysm surgery: the link to perioperative myocardial ischemia. Ann Vasc Surg 7(3):213–219

    Article  CAS  PubMed  Google Scholar 

  19. Ballantyne JC, Kupelnick B, McPeek B, Lau J (2005) Does the evidence support the use of spinal and epidural anesthesia for surgery? J Clin Anesth 17(5):382–391

    Article  PubMed  Google Scholar 

  20. Beattie WS, Badner NH, Choi P (2001) Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg 93(4):853–858

    Article  CAS  PubMed  Google Scholar 

  21. Mythen MG (2005) Postoperative gastrointestinal tract dysfunction. Anesth Analg 100(1):196–204

    Article  PubMed  Google Scholar 

  22. Bauer AJ, Boeckxstaens GE (2004) Mechanisms of postoperative ileus. Neurogastroenterol Motil 16 (Suppl 2(s2)):54–60

    Article  PubMed  Google Scholar 

  23. Qaseem A, Snow V, Fitterman N et al (2006) Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med 575–580

  24. Warner DO (2000) Preventing postoperative pulmonary complications: the role of the anesthesiologist. Anesthesiology 92(5):1467–1472

    Article  CAS  PubMed  Google Scholar 

  25. Marx C, Rasmussen T, Jakobsen DH et al (2006) The effect of accelerated rehabilitation on recovery after surgery for ovarian malignancy. Acta Obstet Gynecol Scand 85(4):488–492

    Article  PubMed  Google Scholar 

  26. Catro-Alves LJS, De Azevedo VLF, De Freitas Braga TF et al (2011) The effect of neuraxial versus general anesthesia techniques on postoperative quality of recovery and analgesia after abdominal hysterectomy: a prospective, randomized, controlled trial. Anesth Analg 113(6):1480–1486

    Article  CAS  PubMed  Google Scholar 

  27. Rivard C, Dickson EL, Vogel RI et al (2014) The effect of anesthesia choice on post-operative outcomes in women undergoing exploratory laparotomy for a suspected gynecologic malignancy. Gynecol Oncol 133(2):278–282

    Article  PubMed  Google Scholar 

  28. Gogarten W, Van Aken H (2005) Current concepts in neuraxial anaesthesia for labour and delivery. Zentralbl Gynakol 127(6):361–367

    Article  CAS  PubMed  Google Scholar 

  29. Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, Berufsverband Deutscher Anästhesisten, Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (2009) Durchführung von Analgesie- und Anästhesieverfahren in der Geburtshilfe. Anaesth Intensivmed 50:502–507

    Google Scholar 

  30. Moen V, Dahlgren N, Irestedt L (2004) Severe neurological complications after central neuraxial blockades in Sweden 1990–1999. Anesthesiology 101(4):950–959

    Article  CAS  PubMed  Google Scholar 

  31. Vandermeulen EP, Van Aken H, Vermylen J (1994) Anticoagulants and spinal-epidural anesthesia. Anesth Analg 79(6):1165–1177

    Article  CAS  PubMed  Google Scholar 

  32. Waurick K, Riess H, Van Aken H et al (2014) S1-Leitlinie Rückenmarksnahe Regionalanästhesien und Thrombembolieprophylaxe/antithrombotische Medikation. Anasth Intensivmed 55:464–492

    Google Scholar 

  33. Radke K, Radke OC (2013) Post-dural puncture headache. Anaesthesist 62(2):149–161

    Article  CAS  PubMed  Google Scholar 

  34. Morin A, Kerwat KM, Büttner J et al (2006) Hygiene recommendations for the initiation and continued care of regional anaesthetic procedures. Anaesth Intensivmed 47:372–379

    Google Scholar 

  35. Pöpping DM, Zahn PK, Van Aken HK et al (2008) Effectiveness and safety of postoperative pain management: a survey of 18,925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data. Br J Anaesth 101(6):832–840

    Article  PubMed  Google Scholar 

  36. Grewal S, Hocking G, Wildsmith JAW (2006) Epidural abscesses. Br J Anaesth 96(3):292–302

    Article  CAS  PubMed  Google Scholar 

  37. Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (1992) Stellungnahme zur Frage der erlaubten Zeit zwischen Indikationsstellung und Sectio (E-E-Zeit). AWMF

  38. Lucas DN (2010) The 30 minute decision to delivery time is unrealistic in morbidly obese women. Int J Obstet Anesth 19(4):431–435

    Article  CAS  PubMed  Google Scholar 

  39. Soens MA, Birnbach DJ, Ranasinghe JS, Zundert A van (2008) Obstetric anesthesia for the obese and morbidly obese patient: an ounce of prevention is worth more than a pound of treatment. Acta Anaesthesiol Scand 52(1):6–19

    Article  PubMed  Google Scholar 

  40. Capogna G, Camorcia M, Stirparo S, Farcomeni A (2011) Programmed intermittent epidural bolus versus continuous epidural infusion for labor analgesia: the effects on maternal motor function and labor outcome. A randomized double-blind study in nulliparous women. Anesth Analg 113(4):826–831

    PubMed  Google Scholar 

  41. Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA (2005) Obstetric anesthesia workforce survey: twenty-year update. Anesthesiology 103(3):645–653

    Article  PubMed  Google Scholar 

  42. Hill D (2008) Remifentanil in obstetrics. Curr Opin Anaesthesiol 21(3):270–274

    Article  PubMed  Google Scholar 

  43. Hinova A, Fernando R (2009) Systemic remifentanil for labor analgesia. Anesth Analg 109(6):1925–1929

    Article  CAS  PubMed  Google Scholar 

  44. Khan KS, Wojdyla D, Say L et al (2006) WHO analysis of causes of maternal death: a systematic review. Lancet 367(9516):1066–1074

    Article  PubMed  Google Scholar 

  45. Haeri S, Dildy GA (2012) Maternal mortality from hemorrhage. Semin Perinatol 36(1):48–55

    Article  PubMed  Google Scholar 

  46. Ronsmans C, Graham WJ, Lancet Maternal Survival Series steering group (2006) Maternal mortality: who, when, where, and why. Lancet 368(9542):1189–1200

    Article  PubMed  Google Scholar 

  47. Schlembach D, Mortl MG, Girard T et al (2014) Management of postpartum hemorrhage (PPH): algorithm of the interdisciplinary D-A-CH consensus group PPH (Germany – Austria – Switzerland). Anaesthesist 63(3):234–242

    Article  CAS  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. Keine Angaben

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Klinik für operative Intensivmedizin und Intermediate Care, Universitätsklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    T. Breuer, G. Marx & C. Brülls

  2. Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinik der RWTH Aachen, Aachen, Deutschland

    D. Bauerschlag & N. Maass

Authors
  1. T. Breuer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Marx
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Bauerschlag
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Maass
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Brülls
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Breuer.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Breuer, T., Marx, G., Bauerschlag, D. et al. Anästhesieverfahren in Gynäkologie und Geburtshilfe. Gynäkologe 48, 51–64 (2015). https://doi.org/10.1007/s00129-014-3489-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00129-014-3489-7

Schlüsselwörter

Keywords

Search

Navigation