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Anästhesiologisches Management in der Alterstraumatologie

Anesthesiological management of elderly trauma patients

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Zusammenfassung

Hintergrund

Der demografische Wandel bringt eine stetige Zunahme der Patienten in der Alterstraumatologie mit sich. Diese Patienten weisen eine hohe Zahl an Komorbiditäten auf und haben folglich ein entsprechend hohes perioperatives Risiko für postoperative Morbidität und Letalität. Die Dreißigtageletalität dieser Patienten ist hoch.

Ziel der Arbeit

Es soll eine Übersicht über wichtige Aspekte des anästhesiologischen Managements in der Alterstraumatologie gegeben werden. Dies kann dazu dienen, das perioperative Outcome dieser Hochrisikopatienten zu verbessern.

Material und Methoden

Es erfolgte eine Analyse der aktuellen Literatur als Grundlage für eine Darstellung des prä-, intra- und postoperativen anästhesiologischen Managements in der Alterstraumatologie.

Ergebnisse

Eine zeitnahe Versorgung der alterstraumatologischen Patienten ist wichtig. Viele dieser Patienten weisen ein hohes perioperatives Risikoprofil auf. Dieses kann mithilfe von Scores berechnet werden, um Aussagen über die Prognose der Patienten zu ermöglichen. Entsprechend kann die Aufklärung der Patienten erfolgen. Der Behandlungspfad bedarf einer multidisziplinären Planung. Viele Fragestellungen des perioperativen Managements, wie z. B. nach dem bestgeeigneten Anästhesieverfahren, dem idealen individuellen Transfusionstrigger, dem Volumenmanagement u.v.m., sind noch nicht ausreichend durch Studien geklärt.

Schlussfolgerung

Der Evidenzgrad der perioperativen Versorgung in der Alterstraumatologie ist schwach. Aufgrund dessen sind große prospektive Studien ein dringendes Forschungsziel, um einheitliche Standards und Richtlinien zu definieren.

Abstract

Background

The demographic change is accompanied by an increasing number of elderly trauma patients. Geriatric patients with trauma often show several comorbidities and as a result have a high perioperative risk to develop postoperative morbidity and mortality. The 30-day mortality is high.

Aim

This article presents an overview of the perioperative management of elderly trauma patients in order to improve the perioperative outcome of these high risk patients.

Material and methods

A literature search was carried out focusing on the latest developments in the field of elderly trauma patients in order to present guidance on preoperative, intraoperative and postoperative anesthesiological management.

Results

Elderly trauma patients should undergo operative interventions as soon as possible. Many of these patients have a high risk profile. This can be estimated using risk scores in order to allow a prognosis for the outcome of patients. The informed consent needs to be discussed accordingly. The perioperative management is ideally addressed in a multidisciplinary approach. An array of questions in perioperative management, such as the mode of anesthesia, the ideal individual transfusion trigger and fluid management have not yet been adequately addressed in studies.

Conclusion

The level of evidence in the perioperative management of elderly trauma patients is poor; therefore, there is an urgent need for large prospective studies in order to define uniform standards and guidelines.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    M. Coburn, A. B. Röhl, A. Stevanovic, C. Stoppe & R. Rossaint

  2. Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum RWTH Aachen, Aachen, Deutschland

    M. Knobe

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  1. M. Coburn
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  2. A. B. Röhl
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  3. M. Knobe
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  5. C. Stoppe
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Correspondence to M. Coburn.

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Coburn, M., Röhl, A.B., Knobe, M. et al. Anästhesiologisches Management in der Alterstraumatologie. Anaesthesist 65, 98–106 (2016). https://doi.org/10.1007/s00101-016-0136-9

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