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Erschienen in: Die Anaesthesiologie 10/2019

14.06.2019 | Anästhesiologisches Vorgehen bei Herz-Kreislauferkrankungen | Leitthema

Perioperative kardiovaskuläre Morbidität und Letalität bei nichtherzchirurgischen Eingriffen

Maßnahmen der optimalen anästhesiologischen Betreuung

verfasst von: H. Janßen, S. Dehne, E. Giannitsis, M. A. Weigand, Dr. med. J. Larmann, PhD

Erschienen in: Die Anaesthesiologie | Ausgabe 10/2019

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Zusammenfassung

Die perioperative Morbidität und Letalität haben sich in den letzten Jahrzehnten u. a. durch fortschrittliche Operationstechniken, umfangreichere Überwachungsmöglichkeiten und effektivere perioperative Medizin deutlich reduziert. Jedoch besteht insbesondere für kardiovaskulär vorerkrankte Patienten weiterhin ein nichtunerhebliches perioperatives Morbiditäts- und Letalitätsrisiko. Diese vulnerable Patientengruppe bedarf während der gesamten perioperativen Phase der besonderen interdisziplinären Aufmerksamkeit. Der Prämedikationsvisite kommt eine tragende Rolle zu. Neben der Erhebung einer gründlichen Anamnese und einer körperlichen Untersuchung werden der perioperative Umgang mit der Dauermedikation des Patienten geplant und die Notwendigkeit weiterer diagnostischer Tests geprüft. Wenn notwendig und möglich, kann die Optimierung des Gesundheitszustandes unter Einbeziehung weiterer Disziplinen geplant werden. Intraoperativ obliegt es dem Anästhesisten, den kardiovaskulär vorerkrankten Patienten optimal durch den chirurgischen Eingriff zu begleiten. In dieser Übersichtsarbeit werden Maßnahmen zusammengefasst, die die perioperative Morbidität und Letalität dieser Patienten beeinflussen können und die zugrunde liegende Evidenz bewertet. Hierzu zählen eine perioperative kardioprotektive Medikation, die Auswahl des geeigneten Anästhesieverfahrens, Blutdruckmanagement und Transfusionsstrategien. Darüber hinaus werden die therapeutischen Möglichkeiten perioperativer kardiovaskulärer Ereignisse erläutert und ein Algorithmus für den Umgang mit Patienten vorgeschlagen, die einen perioperativen Myokardschaden ohne ischämietypische Symptome („myocardial injury after non-cardiac surgery“) erlitten haben.
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Metadaten
Titel
Perioperative kardiovaskuläre Morbidität und Letalität bei nichtherzchirurgischen Eingriffen
Maßnahmen der optimalen anästhesiologischen Betreuung
verfasst von
H. Janßen
S. Dehne
E. Giannitsis
M. A. Weigand
Dr. med. J. Larmann, PhD
Publikationsdatum
14.06.2019
Verlag
Springer Medizin
Erschienen in
Die Anaesthesiologie / Ausgabe 10/2019
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI
https://doi.org/10.1007/s00101-019-0616-9

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