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Erschienen in: Der Anaesthesist 5/2015

01.05.2015 | Leitthema

Anästhesie und Schmerztherapie während der Schwangerschaft

verfasst von: Dr. T. Ninke, Dr. S. Thoma-Jennerwein, Dr. J. Blunk, Prof. Dr. T. Annecke

Erschienen in: Die Anaesthesiologie | Ausgabe 5/2015

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Zusammenfassung

Im Rahmen der peri- und postoperativen Betreuung einer Schwangeren muss im besonderen Maß den veränderten physiologischen Bedingungen Rechnung getragen werden. Grundprinzipen der Versorgung sind die Aufrechterhaltung der maternalen und fetalen Homöostase sowie eine Vermeidung von für den Fetus schädlichen Substanzen. Bei der Planung eines Eingriffs müssen alle beteiligten Fachdisziplinen rechtzeitig involviert werden. Für die Durchführung einer Allgemeinanästhesie scheinen die modernen Anästhetika insgesamt gut geeignet zu sein. Es fehlen bisher sichere Hinweise auf human-teratogene Effekte einzelner Substanzen. Perioperativ ist auf die adäquate Überwachung und Beurteilung des Fetus zu achten.
Die Schmerztherapie während der Schwangerschaft orientiert sich prinzipiell am Stufenschema der World Health Organization (WHO). Jedoch dürfen nur Substanzen zum Einsatz kommen, die keinen embryo- oder fetotoxischen Effekt besitzen. Bei den Nichtopioidanalgetika kommt dem Paracetamol eine wesentliche Rolle zu. Innerhalb enger Grenzen kann auch der Einsatz von nichtsteroidalen Antirheumatika (NSAR) gerechtfertigt sein. Nach der 28. Schwangerschaftswoche sind sie kontraindiziert. Tramadol ist niedrig-potentes Opioid der 1. Wahl. Bei den hochpotenten Opioiden kann nach Risiko-Nutzen-Abwägung die Verabreichung von Morphin sinnvoll sein. Antikonvulsiva sollten nach Möglichkeit als Koanalgetikum vermieden werden. Im Bedarfsfall empfiehlt sich hier stattdessen die Gabe von besser untersuchten Antidepressiva. Neben der medikamentösen Schmerztherapie sollten auch nichtmedikamentöse konservative Therapieoptionen zur Behandlung von Schmerzen zum Einsatz kommen.
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Metadaten
Titel
Anästhesie und Schmerztherapie während der Schwangerschaft
verfasst von
Dr. T. Ninke
Dr. S. Thoma-Jennerwein
Dr. J. Blunk
Prof. Dr. T. Annecke
Publikationsdatum
01.05.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Anaesthesiologie / Ausgabe 5/2015
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI
https://doi.org/10.1007/s00101-015-0023-9

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