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Die Aufgabe der Anästhesiologie bei der Umsetzung operativer „Fast track-Konzepte“

Darstellung am Beispiel der Fast-track-Kolonchirurgie

The role of anesthesiology in fast track concepts in colonic surgery

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Zusammenfassung

In der vorliegenden Arbeit werden Grundlagen und Ergebnisse der „Fast-track-Rehabilitation“ bei 208 Patienten vorgestellt, die sich in der Charité einem elektiven kolonchirurgischen Eingriff unterzogen haben. Dabei wird das Hauptaugenmerk auf anästhesiologische Aspekte dieses multimodalen Konzeptes gerichtet. Dazu gehören Modifikationen der prä- und postoperativen Flüssigkeits- und Nahrungskarenz, eine opioidsparende Analgesie unter Verwendung thorakaler Periduralkatheter und Nichtopioidanalgetika, die Anwendung kurz wirkender und gut steuerbarer Anästhetika sowie die Einhaltung der Prinzipien von Normothermie und Normovolämie. Im Vergleich zu den Outcome-Daten vor Einführung der Fast-track-Rehabilitation ist es gelungen, die postoperative Rekonvaleszenz zu beschleunigen und die Rate allgemeiner postoperativer Komplikationen deutlich zu vermindern. So konnte die durchschnittliche postoperative Verweildauer nach Kolonresektionen von 12 Tagen auf 5 Tage reduziert werden. Die Inzidenz allgemeiner Komplikationen, wie Pneumonie, Harnwegsinfekt, Ulkusblutung, renale, zerebrale und kardiale Funktionsstörungen, konnte von 20% auf 7% reduziert werden. Die Häufigkeit chirurgischer Komplikationen blieb mit 17% (u. a. 8% Wundheilungsstörungen und 3% Anastomoseninsuffizienzen) ungefähr gleich und entspricht damit den in der Literatur für laparoskopisch-kolonchirurgische Eingriffe angegebenen Daten.

Abstract

In the present study the “fast-track rehabilitation” protocol of the Charité university hospital for patients undergoing elective colonic resection is described. The underlying principles, clinical pathways and outcome data from 208 patients are shown. Particularly anesthesiological aspects of this multimodal approach, such as modified preoperative and postoperative fluid management, changed guidelines for preoperative fasting, effective analgetic therapy using epidural analgesia and avoiding high systemic doses of opioids, use of short-acting anesthetic agents, and maintenance of normothermia as well as normovolemia are presented and discussed. In comparison to outcome data before “fast-track rehabilitation” was established, the duration of postoperative hospital stay has been reduced from 12 to 5 days, the number of general complications (pneumonia, duodenal ulcer bleeding, urinary tract infection, cerebral, cardiac and renal dysfunction) decreased from 20% to 7%, whereas surgical complications remained constant at 17% (8% wound infections, 3% anastomotic insufficiency).

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  1. Klinik für Anästhesiologie und operative Intensivmedizin, Campus Charité Mitte, Universitätsmedizin, Berlin

    M. Hensel, A. Bloch, S. Stracke, T. Volk, C. v. Heymann, W. J. Kox & C. Spies

  2. Klinik für Allgemein-, Visceral-, Gefäß- und Thoraxchirurgie, Campus Charité Mitte, Universitätsmedizin, Berlin

    W. Schwenk, W. Raue & J. M. Müller

  3. Klinik für Anästhesiologie und operative Intensivmedizin, Charité Mitte, Universitätsmedizin, Schumannstr. 20/ 21, 10117, Berlin

    M. Hensel

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  1. M. Hensel
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  3. A. Bloch
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Hensel, M., Schwenk, W., Bloch, A. et al. Die Aufgabe der Anästhesiologie bei der Umsetzung operativer „Fast track-Konzepte“. Anaesthesist 55, 80–92 (2006). https://doi.org/10.1007/s00101-005-0923-1

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