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Anästhesie bei bariatrischer Chirurgie

Anesthesia and bariatric surgery

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Zusammenfassung

Adipositas wird mittlerweile als eigenständige Krankheit anerkannt. Die World Health Organization (WHO) spricht von einer weltweiten Epidemie. Folgeerkrankungen betreffen alle Organsysteme. Bariatrische Operationen führen bereits frühzeitig nach der Durchführung zu einer Verbesserung oder gar Remission der adipositasassoziierten Komorbiditäten. Bei bariatrischen Operationen wird zwischen restriktiven, das Magenvolumen verkleinernden Verfahren, malabsorptiven und gemischten Verfahren differenziert. Die präoperative anästhesiologische Evaluation der Begleiterkrankungen erfolgt mit besonderem Augenmerk auf bestehende Herz- und Lungenfunktionseinschränkungen (z. B. Kardiomyopathien, obstruktive Ventilationsstörungen). Bei extrem adipösen Patienten besteht erhöhte Aspirationsgefahr. Die Narkoseeinleitung kann konventionell, bei zusätzlichen Risikofaktoren fiberoptisch oder als „rapid sequence induction“ erfolgen. Die Pharmakokinetik aller eingesetzten Substanzen ist im Vergleich zum normalgewichtigen Patienten stark verändert. Postoperative Thromboembolien stellen das höchste Letalitätsrisiko dar; deshalb muss eine suffiziente medikamentöse und nichtmedikamentöse Thromboseprophylaxe erfolgen.

Abstract

Today obesity is accepted as an independent disease. The WHO describes obesity as an epidemic disease occurring worldwide and associated comorbidities affect all organ systems. Bariatric operations lead to an improvement or even complete remission of obesity-correlated comorbidities. Bariatric operations are conducted as restrictive, malabsorptive, or mixed procedures. The preoperative anesthetic evaluation of comorbidities is carried out with a special focus on preexisting impairments of cardiac and lung function (e.g. cardiomyopathy, obstructive respiratory dysfunctions). Extremely obese patients are at risk of aspiration. Airway management at anesthesia induction includes normal intubation or, if additional risk factors are present, either fiber optic awake intubation or rapid sequence induction. The pharmacokinetics of all applicable drugs are altered in extremely obese patients and they are at risk for developing postoperative thromboembolic complications with a high mortality rate. Therefore early and sufficient thrombotic prophylaxis is important.

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Authors and Affiliations

  1. Klinik für Anaesthesiologie und Intensivmedizin, Universitätsklinik Tübingen, Tübingen, Deutschland

    F.M. Konrad

  2. Chirurgische Klinik München-Bogenhausen GmbH, München, Deutschland

    K.M. Kramer

  3. Klinik für Anästhesiologie und Intensivmedizin, Karl-Olga-Krankenhaus GmbH, Hackstr. 61, 70190, Stuttgart, Deutschland

    T.H. Schroeder

  4. Abteilung für Anästhesie, Krankenhaus Sachsenhausen, Frankfurt a. M., Deutschland

    K. Stubbig

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  1. F.M. Konrad
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  2. K.M. Kramer
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  3. T.H. Schroeder
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  4. K. Stubbig
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Correspondence to T.H. Schroeder.

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Konrad, F., Kramer, K., Schroeder, T. et al. Anästhesie bei bariatrischer Chirurgie. Anaesthesist 60, 607–616 (2011). https://doi.org/10.1007/s00101-011-1922-z

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