Advertisement

Gefässchirurgie

, Volume 23, Issue 3, pp 136–144 | Cite as

Anästhesiologisches Management des abdominellen Aortenaneurysmas

  • J. Knapp
  • A. Walther
Leitthema
  • 142 Downloads

Zusammenfassung

Der folgende Artikel beschreibt spezielle Aspekte des anästhesiologischen Vorgehens im Rahmen von elektiven sowie notfallmäßigen Operationen abdomineller Aortenaneurysmen, die im klinischen Alltag häufig zu Unsicherheiten und Diskussionen führen. Beginnend von den präoperativen Vorbereitungen des Patienten und der Auswahl des idealen Anästhesieverfahrens, über den Sinn von zusätzlichem intraoperativem Monitoring bis hin zum intraoperativen Management der Hämodynamik und der Blutgerinnung sowie den Möglichkeiten der Nephroprotektion und der notfallmäßigen Versorgung des Patienten mit rupturiertem Aortenaneurysma wird die aktuelle Studienlage dargestellt. Soweit wie möglich werden daraus Empfehlungen für eine optimale anästhesiologische Therapie abgeleitet.

Schlüsselwörter

Abdominelles Aortenaneurysma Anästhesie Perioperatives Management Intraoperatives Monitoring Endovaskuläre Therapie 

Anesthetic management of abdominal aortic aneurysms

Abstract

The following article describes several aspects of the anesthetic management of patients presenting for elective or emergency surgery of an abdominal aortic aneurysm that frequently lead to uncertainties and discussions in the clinical routine. We present the current state of relevant studies and guidelines regarding the preoperative evaluation, the choice of the ideal anesthetic technique, the significance of additional intraoperative monitoring, hemodynamic and coagulation management as well as possible options of nephroprotection and the anesthetic management of ruptured abdominal aortic aneurysms. If possible, some recommendations for the optimal anesthetic management of these patients are derived from the results of current studies.

Keywords

Abdominal aortic aneurysm Anesthesia Perioperative management Intraoperative monitoring Endovascular aortic aneurysm repair 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Knapp und A. Walther geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Brimacombe J, Berry A (1993) A review of anaesthesia for ruptured abdominal aortic aneurysm with special emphasis on preclamping fluid resuscitation. Anaesth Intensive Care 21:311–323PubMedGoogle Scholar
  2. 2.
    Group GTC, Lewis SC, Warlow CP et al (2008) General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial. Lancet 372:2132–2142CrossRefGoogle Scholar
  3. 3.
    Kristensen SD, Knuuti J, Saraste A et al (2014) 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: the Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur J Anaesthesiol 31:517–573CrossRefPubMedGoogle Scholar
  4. 4.
    DGAI, DGCH, DGIM. (2017) Präoperative Evaluation erwachsener Patienten vor elektiven, nicht herz-thoraxchirurgischen Eingriffen. Anästh Intensivmed 58:349–364Google Scholar
  5. 5.
    London MJ, Hur K, Schwartz GG et al (2013) Association of perioperative beta-blockade with mortality and cardiovascular morbidity following major noncardiac surgery. JAMA 309:1704–1713CrossRefPubMedGoogle Scholar
  6. 6.
    Sanfilippo F, Santonocito C, Foex P (2014) Use of beta-blockers in non-cardiac surgery: an open debate. Minerva Anestesiol 80:482–494PubMedGoogle Scholar
  7. 7.
    Group PS, Devereaux PJ, Yang H et al (2008) Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 371:1839–1847CrossRefGoogle Scholar
  8. 8.
    Wallace AW, Au S, Cason BA (2011) Perioperative beta-blockade: atenolol is associated with reduced mortality when compared to metoprolol. Anesthesiology 114:824–836CrossRefPubMedGoogle Scholar
  9. 9.
    Ashes C, Judelman S, Wijeysundera DN et al (2013) Selective beta1-antagonism with bisoprolol is associated with fewer postoperative strokes than atenolol or metoprolol: a single-center cohort study of 44,092 consecutive patients. Anesthesiology 119:777–787CrossRefPubMedGoogle Scholar
  10. 10.
    Turan A, Babazade R, Kurz A et al (2016) Clonidine does not reduce pain or opioid consumption after noncardiac surgery. Anesth Analg 123:749–757CrossRefPubMedGoogle Scholar
  11. 11.
    Waurick K, Riess H, Van Aken H, Kessler P, Gogarten W, Volk T (2014) Rückenmarksnahe Regionalanästhesien und Thrombembolieprophylaxe/antithrombotische Medikation. Anästh Intensivmed 55:464–492Google Scholar
  12. 12.
    Werawatganon T, Charuluxanun S (2005) Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD004088.pub2 PubMedGoogle Scholar
  13. 13.
    Bardia A, Sood A, Mahmood F et al (2016) Combined epidural-general anesthesia vs general anesthesia alone for elective abdominal aortic aneurysm repair. JAMA Surg 151:1116–1123CrossRefPubMedGoogle Scholar
  14. 14.
    Guay J, Kopp S (2016) Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD005059.pub4 Google Scholar
  15. 15.
    Fleisher LA, Fleischmann KE, Auerbach AD et al (2014) 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 64:e77–e137CrossRefPubMedGoogle Scholar
  16. 16.
    Ruppert V, Leurs LJ, Steckmeier B et al (2006) Influence of anesthesia type on outcome after endovascular aortic aneurysm repair: an analysis based on EUROSTAR data. J Vasc Surg 44:16–21 (discussion 21)CrossRefPubMedGoogle Scholar
  17. 17.
    Edwards MS, Andrews JS, Edwards AF et al (2011) Results of endovascular aortic aneurysm repair with general, regional, and local/monitored anesthesia care in the American College of Surgeons National Surgical Quality Improvement Program database. J Vasc Surg 54:1273–1282CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Karthikesalingam A, Thrumurthy SG, Young EL et al (2012) Locoregional anesthesia for endovascular aneurysm repair. J Vasc Surg 56:510–519CrossRefPubMedGoogle Scholar
  19. 19.
    IMPROVE trial investigators, Powell JT, Hinchliffe RJ et al (2014) Observations from the IMPROVE trial concerning the clinical care of patients with ruptured abdominal aortic aneurysm. Br J Surg 101:216–224 (discussion 224)CrossRefPubMedCentralGoogle Scholar
  20. 20.
    Hainer C, Bernhard M, Scheuren K et al (2006) Echocardiography during acute hemodynamic instability. Anaesthesist 55:1117–1131 (quiz 1132.)CrossRefPubMedGoogle Scholar
  21. 21.
    Siddiqi N, Harrison JK, Clegg A et al (2016) Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD005563.pub3 Google Scholar
  22. 22.
    Adesanya A, Rosero E, Timaran C et al (2008) Intraoperative fluid restriction predicts improved outcomes in major vascular surgery. Vasc Endovascular Surg 42:531–536CrossRefPubMedGoogle Scholar
  23. 23.
    Moll FL, Powell JT, Fraedrich G et al (2011) Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg 41(Suppl 1):S1–S58CrossRefPubMedGoogle Scholar
  24. 24.
    Hilbert-Carius P, Wurmb T, Lier H et al (2017) Care for severely injured persons : update of the 2016 S3 guideline for the treatment of polytrauma and the severely injured. Anaesthesist 66:195–206CrossRefPubMedGoogle Scholar
  25. 25.
    Dick F, Erdoes G, Opfermann P et al (2013) Delayed volume resuscitation during initial management of ruptured abdominal aortic aneurysm. J Vasc Surg 57:943–950CrossRefPubMedGoogle Scholar
  26. 26.
    Hinchliffe RJ, Powell JT (2013) Improving the outcomes from ruptured abdominal aortic aneurysm: interdisciplinary best practice guidelines. Ann R Coll Surg Engl 95:96–97CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Hope K, Nickols G, Mouton R (2016) Modern anesthetic management of ruptured abdominal aortic aneurysms. J Cardiothorac Vasc Anesth 30:1676–1684CrossRefPubMedGoogle Scholar
  28. 28.
    Erbel R, Aboyans V, Boileau C et al (2014) 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 35:2873–2926CrossRefPubMedGoogle Scholar
  29. 29.
    CRASH-2 trial collaborators, Shakur H, Roberts I et al (2010) Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 376:23–32CrossRefGoogle Scholar
  30. 30.
    Safi HJ, Harlin SA, Miller CC et al (1996) Predictive factors for acute renal failure in thoracic and thoracoabdominal aortic aneurysm surgery. J Vasc Surg 24:338–344 (discussion 344–335)CrossRefPubMedGoogle Scholar
  31. 31.
    O’Connor CJ, Rothenberg DM (1995) Anesthetic considerations for descending thoracic aortic surgery: part II. J Cardiothorac Vasc Anesth 9:734–747CrossRefPubMedGoogle Scholar
  32. 32.
    Alpert RA, Roizen MF, Hamilton WK et al (1984) Intraoperative urinary output does not predict postoperative renal function in patients undergoing abdominal aortic revascularization. Surgery 95:707–711PubMedGoogle Scholar
  33. 33.
    Sugimoto M, Takahashi N, Niimi K et al (2017) Long-term fate of renal function after open surgery for juxtarenal and pararenal aortic aneurysm. J Vasc Surg.  https://doi.org/10.1016/j.jvs.2017.07.121 PubMedGoogle Scholar
  34. 34.
    Godet G, Fleron MH, Vicaut E et al (1997) Risk factors for acute postoperative renal failure in thoracic or thoracoabdominal aortic surgery: a prospective study. Anesth Analg 85:1227–1232CrossRefPubMedGoogle Scholar
  35. 35.
    Gelman S, Reves JG, Fowler K et al (1983) Regional blood flow during cross-clamping of the thoracic aorta and infusion of sodium nitroprusside. J Thorac Cardiovasc Surg 85:287–291PubMedGoogle Scholar
  36. 36.
    Nicholson ML, Baker DM, Hopkinson BR et al (1996) Randomized controlled trial of the effect of mannitol on renal reperfusion injury during aortic aneurysm surgery. Br J Surg 83:1230–1233CrossRefPubMedGoogle Scholar
  37. 37.
    Lassnigg A, Donner E, Grubhofer G et al (2000) Lack of renoprotective effects of dopamine and furosemide during cardiac surgery. J Am Soc Nephrol 11:97–104PubMedGoogle Scholar
  38. 38.
    Mahesh B, Yim B, Robson D et al (2008) Does furosemide prevent renal dysfunction in high-risk cardiac surgical patients? Results of a double-blinded prospective randomised trial. Eur J Cardiothorac Surg 33:370–376CrossRefPubMedGoogle Scholar
  39. 39.
    Yeung KK, Tangelder GJ, Fung WY et al (2010) Open surgical repair of ruptured juxtarenal aortic aneurysms with and without renal cooling: observations regarding morbidity and mortality. J Vasc Surg 51:551–558CrossRefPubMedGoogle Scholar
  40. 40.
    Yeung KK, Groeneveld M, Lu JJ et al (2016) Organ protection during aortic cross-clamping. Best Pract Res Clin Anaesthesiol 30:305–315CrossRefPubMedGoogle Scholar
  41. 41.
    Vascular Society of Great Britain and Ireland: Best practice guidelines for the management and transfer of patients with a diagnosis of ruptured abdominal aortic aneurysm to a specialist vascular centre. [cited 20.12.2017] Available from: https://www.rcem.ac.uk/docs/College%20Guidelines/5z8.%20Management%20and%20Transfer%20of%20Patients%20with%20a%20diagnosis%20of%20Ruptured%20Abdominal%20Aortic%20Aneurysm.pdf. Zugegriffen: 28.03.2018
  42. 42.
    Hinchliffe RJ, Ribbons T, Ulug P et al (2013) Transfer of patients with ruptured abdominal aortic aneurysm from general hospitals to specialist vascular centres: results of a Delphi consensus study. Emerg Med J 30:483–486CrossRefPubMedGoogle Scholar
  43. 43.
    Rubenstein C, Bietz G, Davenport DL et al (2015) Abdominal compartment syndrome associated with endovascular and open repair of ruptured abdominal aortic aneurysms. J Vasc Surg 61:648–654CrossRefPubMedGoogle Scholar
  44. 44.
    Kirkpatrick AW, Roberts DJ, De Waele J et al (2013) Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med 39:1190–1206CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Djavani Gidlund K, Wanhainen A, Bjorck M (2011) Intra-abdominal hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 41:742–747CrossRefPubMedGoogle Scholar
  46. 46.
    Karkos CD, Menexes GC, Patelis N et al (2014) A systematic review and meta-analysis of abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg 59:829–842CrossRefPubMedGoogle Scholar
  47. 47.
    Mayer D, Rancic Z, Meier C et al (2009) Open abdomen treatment following endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg 50:1–7CrossRefPubMedGoogle Scholar
  48. 48.
    Bjorck M, Wanhainen A (2014) Management of abdominal compartment syndrome and the open abdomen. Eur J Vasc Endovasc Surg 47:279–287CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Universitätsklinik für Anästhesiologie und SchmerztherapieUniversitätsspital BernBernSchweiz
  2. 2.Klinik für Anästhesiologie und operative IntensivmedizinKatharinenhospital, Klinikum StuttgartStuttgartDeutschland

Personalised recommendations