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Perioperatives Flüssigkeitsmanagement

Eine Analyse der aktuellen Studienlage

Perioperative fluid management

An analysis of the present situation

  • Leitthema
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Zusammenfassung

Das optimale perioperative Flüssigkeitsmanagement wird kontrovers diskutiert. Neben der häufig vorkommenden perioperativen Hypovolämie trägt auch die Hypervolämie entscheidend zur perioperativen Morbidität und Letalität bei, besonders im Hinblick auf verschiedene Krankheitsbilder, präexistente kardiale und pulmonale Funktionseinschränkungen und den operativen Eingriff an sich. Die Konzepte der prä, intra- und postoperativen Flüssigkeitsgabe sind weder ausreichend validiert, noch genügend in ein perioperatives Konzept integriert. Derzeit gelten moderate Flüssigkeitsgaben zur Verbesserung des prä- und postoperativen Wohlbefindens bei klein- bis mittelgroßen chirurgischen Eingriffen als gesichert. Hochrisikopatienten profitieren durch eine zeitgerechte und/oder zielgerichtete Flüssigkeitsgabe unter erweitertem Monitoring. Dem postoperativen Flüssigkeitsmanagement wurde bis dato nicht genügend Aufmerksamkeit geschenkt, aber es scheint durch die Konzepte der „Fast-track-Chirurgie“ neue Anregungen zu bekommen.

Abstract

Optimal perioperative fluid management is still controversial. Besides well known perioperative hypovolaemia, hypervolaemia has an influence on perioperative morbidity and mortality, particularly with regard to the patient’s medical history, a reduced cardiac and pulmonal function and the operation itself. The concepts of preoperative, intraoperative and postoperative fluid administration are neither adequately validated, nor sufficiently integrated into a perioperative concept. At the present, moderate fluid administration to improve preoperative and postoperative outcome is safe in minor or medium surgical procedures. High-risk surgical patients benefit from a time-oriented or/and goal-oriented monitored fluid therapy. In the past only little attention has been concentrated on postoperative fluid management, but may be stimulated by the new concepts of fast track surgery.

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  1. ZARI – Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Universitätsklinikum, Georg-August-Universität, Göttingen

    Y. A. Zausig & B. M. Graf

  2. Klinik für Anaesthesiologie, Universitätsklinikum, Ruprecht-Karls-Universität, Heidelberg

    M. A. Weigand

  3. ZARI – Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Georg-August-Universität, Robert-Koch-Straße 40, 37075, Göttingen

    Y. A. Zausig

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  1. Y. A. Zausig
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  2. M. A. Weigand
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  3. B. M. Graf
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Correspondence to Y. A. Zausig.

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Zausig, Y.A., Weigand, M.A. & Graf, B.M. Perioperatives Flüssigkeitsmanagement. Anaesthesist 55, 371–390 (2006). https://doi.org/10.1007/s00101-006-0988-5

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