Skip to main content
SpringerLink
Log in
Book cover

Fast Track in der operativen Medizin pp 29–38Cite as

Narkoseführung und Erhalt der intraoperativen Homöostase

  • Chapter

  • 2243 Accesses

Auszug

Die optimale perioperative Behandlung der Patienten erfordert ein eng aufeinander abgestimmtes Konzept von Chirurgie, Anästhesie, Schmerztherapie und postoperativer Rehabilitation. Die Aufgabe der Anästhesie in diesem Konzept ist, intraoperativ die Homöostase des Patienten soweit möglich zu erhalten, intraoperative Stressreize adäquat abzuschirmen und einen möglichst rasch extubierten, vigilanten und schmerzfreien Patienten an die weiterbehandelnden Stationen zu übergeben (⊡ Abb. 3.1). Selbstverständlich erfordern operative Eingriffe in unterschiedlichen Körperregionen ein abgestimmtes anästhesiologisches Vorgehen. Insbesondere muss zwischen Eingriffen an Extremitäten oder Kopf und Hals sowie Operationen im Brustkorb oder der Bauchhöhle unterschieden werden. Das nachfolgende Kapitel beschreibt spezielle Aspekte des anästhesiologischen Managements, wie die des adäquaten Monitorings, der Rolle der inspiratorischen Sauerstoffkonzentration, der intra- und postoperativen Analgesie, der Wahrung der Normothermie und des adäquaten intra- und postoperativen Flüssigkeitsmanagements. Dabei wird besonders auf die Prinzipien der Narkoseführung bei mittelgroßen bis großen abdominalchirurgischen Operationen (z. B. kolorektale Resektionen, Magenresektionen, Pankreasresektionen) eingegangen. Die Anpassung dieser Prinzipien auf kleinere Eingriffe, Eingriffe im Brustkorb oder sogar Zweihöhleneingriffe wird in den operationsspezifischen Kapiteln des speziellen Teils vorgenommen.

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

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   29.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  • Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, Zernak C, Danner K, Jokela R, Pocock SJ, Trenkler S, Kredel M, Biedler A, Sessler DI, Roewer N; IMPAC Investigators (2004) A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 350:2441–2451

    Article  PubMed  CAS  Google Scholar 

  • Arieff A (1999) Fatal postoperative pulmonary edema: pathogenesis and literature review. Chest 115:1371–1377

    Article  PubMed  CAS  Google Scholar 

  • Basse L, Thorbol JE, Lossl K, Kehlet H (2004) Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 47:271–277

    Article  PubMed  Google Scholar 

  • Belda FJ, Aguilera L, Garcia de la Asuncion J, Alberti J, Vicente R, Ferrandiz L, Rodriguez R, Company R, Sessler D, Aguilar G, Botello SG, Orti R; Spanish Reduccion de la Tasa de Infeccion Quirurgica Group (2005) Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. JAMA 294:2035–2042

    Article  PubMed  CAS  Google Scholar 

  • Bell BF, Dahl JB, Moore RA, Kalso E (2006) Perioperative ketamine for acute postoperative pain Cochrane Database Syst Rev.: CD00460

    Google Scholar 

  • Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA Jr, Wu CL (2003) Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA 290:2455–2463

    Article  PubMed  CAS  Google Scholar 

  • De Lorenzo C, Calatzis A, Welsch U, Heindl B (2006) Fibrinogen concentrate reverses dilutional coagulopathy induced in vitro by saline but not by hydroxyethyl starch 6%. Anesth Analg 102:1194–200

    Article  PubMed  Google Scholar 

  • Elia N, Lysakowski C, Tramer MR (2005) Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials. Anesthesiology 103:1296–304

    Article  PubMed  CAS  Google Scholar 

  • Frank SM, Fleisher LA, Breslow MJ, Higgins MS, Olson KF, Kelly S, Beattie C (1997) Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA 277:1127–1134

    Article  PubMed  CAS  Google Scholar 

  • Fuchs-Buder T, Eikermann M (2006) Residual neuromuscular blockades: Clinical consequences, freequency and avoidance strategies. Anästhesist 55:7–16

    Article  CAS  Google Scholar 

  • Greif R, Akca O, Horn EP, Kurz A, Sessler DI (2000) Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. Outcomes Research Group. N Engl J Med 342:161–167

    Article  PubMed  CAS  Google Scholar 

  • Harvey S, Harrison DA, Singer M, Ashcroft J, Jones CM, Elbourne D, Bramptom W, Williams D, Young D, Rowan K (2005) PAC-Man study collaboration Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial. Lancet 366:472–477

    Article  PubMed  Google Scholar 

  • Hobbhahn J, Schwall B, Prasser C, Vogel H, Taeger K (1997) Der Einfluß von Sevofluran und Desfluran auf die Einleitungs-und Aufwachphase—ein Vergleich mit den herkömmlichen Inhalationsanästhetika und Propofol. Anästhesiologie & Intensivmedizin 12:607–615

    Google Scholar 

  • Holte, K, Klarkov B, Christensen DS, Lund C, Nielsen KG, Bie P, Kehlet H (2004) Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: a double-blind study. Ann Surg 240:892–899

    Article  PubMed  Google Scholar 

  • Hopf HW, Hunt TK, West JM (1997) Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. Arch Surg 132:997–1005

    PubMed  CAS  Google Scholar 

  • Horowitz PE, Delagarza MA, Pulaski JJ, Smith RA (2004) Flow rates and warming efficacy with hotline and Ranger blood/fluid warmers. Anesth Analg 99:788–92

    Article  PubMed  Google Scholar 

  • Jorgensen H, Wetterslev J, Moiniche S, Dahl JB (2000) Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. The Cochrane Library CD 001893

    Google Scholar 

  • Lobo DN, Bost KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP (2002) Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised trial. Lancet 359:1812–1818

    Article  PubMed  Google Scholar 

  • Kreimeier U (2000) Pathophysiology of fluid imbalance. Crit Care 4 (Suppl 2): S3–S7

    PubMed  Google Scholar 

  • Kurz A, Sessler DI, Lenhardt R (1996) Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 334:1209–1215

    Article  PubMed  CAS  Google Scholar 

  • Marusch F, Koch A, Schmidt U, Zippel R, Geissler S, Pross M, Roessner A, Köckerling F, Gastinger I, Lippert H (2002) Prospektive Multizenterstudien »Kolon-/Rektumkarzinome« als flächendeckende chirurgische Qualitätssicherung. Chirurg 73:138–146

    Article  PubMed  CAS  Google Scholar 

  • Marusch F, Gastinger I, Schneider C, Scheidbach H, Konradt J, Bruch HP, Kohler, Barlehner E, Kockerling F; Laparoscopic Colorectal Surgery Study Group (LCSSG) (2001). Experience as a factor influencing the indications for laparoscopic colorectal surgery and the results. Surg Endosc 15:116–20

    Article  PubMed  CAS  Google Scholar 

  • Müller M, Schück R, Erkens U, Sticher J, Haase C, Hempelmann G (1995) Einflüsse der lumbalen Periduralanästhesie auf den Gewebe-PO2 des Dickdarms beim Menschen. Anästhesiol Intensivmed Notfallmed Schmerzther 30:108–110

    Article  PubMed  Google Scholar 

  • Murphy GS, Szokol JW, Marymont JH, Vender JS, Avram MJ, Rosengart TK, Alawi EA (2003) Recovery of neuromuscular function after cardiac surgery: pancuronium versus rocuronium. Anesth Analg 96:1301–1307

    Article  PubMed  Google Scholar 

  • Myles PS, Leslie K, McNeil J, Forbes A, Chan MT (2004) Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomized controlled trial. Lancet 363:1757–1763

    Article  PubMed  CAS  Google Scholar 

  • Ng SF, Oo CS, Loh KH, Lim PY, Chan YH, Ong BC (2003) A comparative study of three warming interventions to determine the most effective in maintaining perioperative normothermia. Anesth Analg 96:171–176

    Article  PubMed  Google Scholar 

  • Nisanevich V, Felsenstein I, Almogy G, Weissbaum C, Einav S, Matot I (2005) Effect of intraoperative Fluid Management on Outcome after abdominal surgery. Anesthesiology 103:25–32

    Article  PubMed  Google Scholar 

  • Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds RM, Bennett ED (2005) Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. Arandomised, controlled trial [ISRCTN38797445]. Crit Care 9:R687–693

    Article  PubMed  Google Scholar 

  • Prien, T, Backhaus N, Pelster F, Pirchow W, Bunk H, Lawin P (1990) Effect of intraoperative fluid administration and colloid osmotic pressure on the formation of intestinal edema during gastrointestinal surgery. J Clin Anesth 2:317–322

    Article  PubMed  CAS  Google Scholar 

  • Pryor KO, Fahey TJ 3rd, Lien CA, Goldstein PA (2004) Surgical site infection and the routine use of perioperative hyperoxia in a general surgical population: a randomized controlled trial. JAMA 291:79–87

    Article  PubMed  CAS  Google Scholar 

  • Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, Sage D, Futter M, Saville G, Clark T, McMahon S (2000) Reduction of post-operative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomized trials. BMJ 321:1493

    Article  PubMed  CAS  Google Scholar 

  • Röhm D, Piper SN, Suttner S, Schuler S, Boldt J (2006) Early recovery, cognitive function and costs of a desflurane inhalational vs. a total intravenous anaesthesia regimen in long-term surgery. Acta Anaesthesiol Scand 50:14–18

    Article  PubMed  Google Scholar 

  • Schwenk W, Raue W, Haase O, Junghans T, Müller JM (2004) »Fast-track-Kolonchirurgie«. Chirurg 75:508–514

    Article  PubMed  CAS  Google Scholar 

  • Shah MR, Hasselblad V, Stevenson LW, Binanay C, O’Connor CM, Sopko G, Califf RM (2005) Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA 294:1664–1670

    Article  PubMed  CAS  Google Scholar 

  • Shires T, Williams J, Brown F (1961) Acute exchange in extracellular fluids associated with major surgical procedures. Ann Surg 154:803–810

    Article  PubMed  CAS  Google Scholar 

  • Sinclair S, James S, Singer M (1997) Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomized controlled trial. BMJ 315:909–912

    PubMed  CAS  Google Scholar 

  • Steinberg RB, Liu SS, Wu CL, Mackey DC, Grass JA, Ahlen K, Jeppsson L (2002) Comparison of ropivacaine-fentanyl patient-controlled epidural analgesia with morphine intravenous patient-controlled analgesia for perioperative analgesia and recovery after open colon surgery. J Clin Anesth 14:571–577

    Article  PubMed  CAS  Google Scholar 

  • Stellungnahme: DGAI, BDA (2004) Präoperatives Nüchternheitsgebot bei elektiven Eingriffen. Anaesth Intensivmed 45:722

    Google Scholar 

  • Struys MM, Somers AA, van den Eynde N, Herregods LL, Dyzers D, Robays HM, Mortier EP (2002) Cost reduction analysis of propofol vs. sevolflurane: maintenance of anaesthesia für gynaecological surgery using the bispectral index. Eur J Anaesthesiol 19:727–734

    PubMed  CAS  Google Scholar 

  • Tsirogianni AK, Moutsopoulos NM, Moutsopoulos HM (2006) Wound healing: Immunological aspects. Injury 37:S5–S12

    Article  PubMed  Google Scholar 

  • Wallace AW, Galindez D, Salahieh A, Layug EL, Lazo EA, Haratonik KA, Boisvert DM, Kardatzke D (2004) Effect of clonidine on cardiovascular morbidity and mortality after noncardiac surgery. Anesthesiology 101:284–293

    Article  PubMed  CAS  Google Scholar 

  • Wheatley RG, Schug SA, Watson D (2001) Safety and efficacy of postoperative epidural analgesia. Br J Anaesth 87:47–61

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Universitätsklinik für Anästhesiologie und operative Intensivmedizin, Universitätsmedizin Berlin-Charité, Campus Mitte Charitéplatz 1, 10117, Berlin

    Chr. von Heymann Dr. med.

  2. Universitätsklinik für Allgemein, Visceral-, Gefäß- und Thoraxchirurgie, Universitätsmedizin Berlin-Charité, Campus Mitte Charitéplatz 1, 10117, Berlin

    O. Haase Dr. med.

Authors
  1. Chr. von Heymann Dr. med.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. O. Haase Dr. med.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer Medizin Verlag Heidelberg

About this chapter

Cite this chapter

von Heymann, C., Haase, O. (2009). Narkoseführung und Erhalt der intraoperativen Homöostase. In: Fast Track in der operativen Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-39709-0_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-39709-0_3

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-39708-3

  • Online ISBN: 978-3-540-39709-0

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics

Search

Navigation