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Vollrelaxation

Nutzen und Risiken

Deep neuromuscular blockade

Benefits and risks

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Zusammenfassung

Vollrelaxation (TOF-Count = 0) kann Intubationsbedingungen und laryngeale Operationsbedingungen verbessern. Sowohl bei nichtlaparoskopischer als auch bei laparoskopischer Chirurgie optimiert die Vollrelaxation die Operationsbedingungen statistisch signifikant. Die klinische Relevanz ist unklar. Die tiefe neuromuskuläre Blockade verbessert die laparoskopischen Operationsbedingungen bei der Verwendung niedriger intraabdomineller Drücke nur marginal. Bei Laparoskopien zeigen niedrige gegenüber höheren intraabdominellen Drücken keine Outcome-relevanten Vorteile, verschlechtern aber die Operationsbedingungen. Postoperative, residuelle Curarisierung kann durch quantitatives Monitoring und pharmakologische Reversierung/Antagonisierung vermieden werden.

Abstract

Neuromuscular blockade (TOF count = 0) can improve tracheal intubation and microlaryngeal surgery. It is also frequently used in many surgical fields including both nonlaparoscopic and laparoscopic surgery to improve surgical conditions and to prevent sudden muscle contractions. Currently there is a controversy regarding the need and the clinical benefits of deep neuromuscular blockade for different surgical procedures. Deep neuromuscular relaxation improves laparoscopic surgical space conditions only marginally when using low intra-abdominal pressure. There is no outcome-relevant advantage of low compared to higher intra-abdominal pressures, but worsen the surgical conditions. Postoperative, residual curarisation can be avoided by algorithm-based pharmacological reversing and quantitative neuromuscular monitoring.

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  1. Klinik für Anaesthesiologie, Universitätsklinikum Regensburg, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93051, Regensburg, Deutschland

    C. Unterbuchner DESA

  2. Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland

    M. Blobner

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Unterbuchner, C., Blobner, M. Vollrelaxation. Anaesthesist 67, 165–176 (2018). https://doi.org/10.1007/s00101-018-0425-6

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