Zusammenfassung
Das Management des schwierigen Atemwegs und damit die Sicherstellung der Oxygenierung ist die zentrale Aufgabe des Anästhesisten. Respiratorische Probleme stellen nach wie vor die häufigste Einzelursache für rein anästhesiebedingte Zwischenfälle mit schlechtem Outcome dar. Algorithmen sind stufenartige Verfahrensweisen, die aus einer Vielzahl von Empfehlungen abgeleitet werden. Sie sind geeignet, Abläufe zu standardisieren und zu trainieren. Obwohl letztendlich nicht bewiesen werden kann, dass Strategien das Outcome verbessern, sind Experten der Meinung, dass dies im Management des schwierigen Atemwegs eindeutig der Fall ist. Wichtiger als die Frage, welcher Algorithmus, welche Technik und welche Instrumente zur Anwendung kommen, ist, dass jede anästhesiologische Abteilung einen eigenen Algorithmus hat und praktiziert. Dies vor allem darum, weil die eigene Erfahrung im Umgang mit spezifischen Intubationshilfen und Materialien unbedingt in den gewählten Algorithmus einfließen muss. Voraussetzung für den erfolgreichen Einsatz im Notfall ist der regelmäßige Einsatz in der täglichen Praxis. Dies gelingt dann leichter, wenn der Algorithmus möglichst einfach gehalten wird und eine Beschränkung auf wenige Hilfsmittel erfolgt.
Abstract
Management of the difficult airway and maintenance of the oxygenation are the most important tasks of the anesthetist. Respiratory problems are still the most single cause for anesthetic related accidents with bad outcome. Algorithms are stepwise procedures developed from a great number of recommendations. They are well suited to automate and train processes. There is strong agreement among consultants that specific strategies lead to improved outcome, although, strictly spoken, the degree of benefit on airway management cannot be clearly determined. More important than the question, which algorithm, which technique and which instruments should be used is that each department has and practices its own algorithm. This strongly depends on experience with different devices. Daily practice is the condition for the successful use in an emergency situation. The management is easier if one uses a simple algorithm and as few instruments as possible.
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Heidegger, T., Gerig, H. Algorithmen für das Management des schwierigen Atemwegs innerhalb des Krankenhauses. Notfall Rettungsmed 10, 476–481 (2007). https://doi.org/10.1007/s10049-007-0969-5
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DOI: https://doi.org/10.1007/s10049-007-0969-5