Skip to main content

2011 | OriginalPaper | Buchkapitel

15. Balancierte Anästhesie

verfasst von : Dr. Christian Hönemann

Erschienen in: Pharmakotherapie in der Anästhesie und Intensivmedizin

Verlag: Springer Berlin Heidelberg

Zusammenfassung

» Eine Allgemeinanästhesie, die durch eine Kombination verschiedener Anästhetika mit synergistischen pharmakologischen Eigenschaften aufrechterhalten wird, bezeichnet man als balancierte Anästhesie. «
Mononästhesien, d. h. Anästhesien unter Verwendt von nur einem Anästhetikum, werden heute praktinicht mehr durchgeführt. Eine Allgemeinanästhesie wird heute meist aus einer Kombination von mindestens 2.oder mehr Anästhetika aufrechterhalten [41]. Eine Inhalaticanästhesie wird ausschließlich als eine Kombinationsästhesie aus Lachgas (Stickoxydul, N2O), Sauerstoffieinem Inhalationsanästhetikum durchgeführt [5][9][12][ [45][49]. Auch bei einer totalen intravenösen Anästhesie (TIVA) wird ein Hypnotikum (Propofol) mit einem Analge-tikum (z. B. Remifentanil) kombiniert [10]. In der balancierten Anästhesie werden Inhalationsanästhetika mit i.v.-An-ästhetika kombiniert [40].
Heute wird mit dem Begriffder balancierten Anästhesie meistens eine Kombination aus intravenöser Opioidgäbe (Analgesie) und Inhalationsanästhesie (Hypnose) verbunden [47]. Der Begriffist jedoch wie oben bereits erwähnt nicht eng definiert und wurde auch schon für andere Kombinationen von Anästhetika wie z. B. Regionalan-algesie und Inhalationsanästhesie verwendet [44].
Literatur
[1]
Zurück zum Zitat Alghanem SM, Massad IM, Rashed EM, Abu-AIi HM, Daradkeh SS (2009) Optimization of anesthesia antiemetic measures versus combination therapy using dexamethasone or ondansetron for the prevention of postoperative nausea and vomiting. Surg Endosc Alghanem SM, Massad IM, Rashed EM, Abu-AIi HM, Daradkeh SS (2009) Optimization of anesthesia antiemetic measures versus combination therapy using dexamethasone or ondansetron for the prevention of postoperative nausea and vomiting. Surg Endosc
[2]
Zurück zum Zitat Alwardt CM, Redford D, Larson DF (2005) General anesthesia in cardiac surgery: a review of drugs and practices. J Extra Corpor Technol 37:227–235PubMed Alwardt CM, Redford D, Larson DF (2005) General anesthesia in cardiac surgery: a review of drugs and practices. J Extra Corpor Technol 37:227–235PubMed
[3]
Zurück zum Zitat Baum JA (1990) Clinical applications of low flow and closed circuit anesthesia. Acta Anaesthesiol Belg 41:239–247PubMed Baum JA (1990) Clinical applications of low flow and closed circuit anesthesia. Acta Anaesthesiol Belg 41:239–247PubMed
[4]
Zurück zum Zitat Baum JA (1995) [John Snow (1813–1858): experimental studies on rebreathing of anesthetic gases in exhaled air]. Anasthesiol Intensivmed Notfallmed Schmerzther 30:37–41PubMedCrossRef Baum JA (1995) [John Snow (1813–1858): experimental studies on rebreathing of anesthetic gases in exhaled air]. Anasthesiol Intensivmed Notfallmed Schmerzther 30:37–41PubMedCrossRef
[5]
Zurück zum Zitat Baum JA (1997) Low-flow anaesthesia: the sensible and judicious use of inhalation anaesthetics. Acta Anaesthesiol Scand Suppl 111:S264–267 Baum JA (1997) Low-flow anaesthesia: the sensible and judicious use of inhalation anaesthetics. Acta Anaesthesiol Scand Suppl 111:S264–267
[6]
Zurück zum Zitat Baum JA (1998) Die Inhalationsnarkose mit niedrigem Frischgasfluß. Thieme, Stuttgart New York Baum JA (1998) Die Inhalationsnarkose mit niedrigem Frischgasfluß. Thieme, Stuttgart New York
[7]
Zurück zum Zitat Baum JA (2004) The carrier gas in anaesthesia: nitrous oxide/ oxygen, medical air/oxygen and pure oxygen. Curr Opin Anaesthesiol 17:513–516PubMedCrossRef Baum JA (2004) The carrier gas in anaesthesia: nitrous oxide/ oxygen, medical air/oxygen and pure oxygen. Curr Opin Anaesthesiol 17:513–516PubMedCrossRef
[8]
Zurück zum Zitat Baum JA (2005) New and alternative delivery concepts and techniques. Best Pract Res Clin Anaesthesiol 19:415–428PubMedCrossRef Baum JA (2005) New and alternative delivery concepts and techniques. Best Pract Res Clin Anaesthesiol 19:415–428PubMedCrossRef
[9]
Zurück zum Zitat Baum JA, Sievert B, Stanke HG, Brauer K, Sachs G (2000) [Nitrous oxide free low-flow anesthesia]. Anaesthesiol Reanim 25:60–67PubMed Baum JA, Sievert B, Stanke HG, Brauer K, Sachs G (2000) [Nitrous oxide free low-flow anesthesia]. Anaesthesiol Reanim 25:60–67PubMed
[10]
Zurück zum Zitat Brady WJ, Meenan DR, ShankarTR, Balon JA, Mennett DR (2005) Use of a remifentanil and propofol combination in outpatients to facilitate rapid discharge home. AANA J 73:207–210PubMed Brady WJ, Meenan DR, ShankarTR, Balon JA, Mennett DR (2005) Use of a remifentanil and propofol combination in outpatients to facilitate rapid discharge home. AANA J 73:207–210PubMed
[11]
Zurück zum Zitat Brody S (1945) Bioenergetics and Growth. Reinhold, New York Brody S (1945) Bioenergetics and Growth. Reinhold, New York
[12]
Zurück zum Zitat Cheeley LN (1956) Nitrous oxide, trichlorethylene, and ether; a balanced anesthesia in obstetrics. Curr Res Anesth Analg 35: 422–424PubMed Cheeley LN (1956) Nitrous oxide, trichlorethylene, and ether; a balanced anesthesia in obstetrics. Curr Res Anesth Analg 35: 422–424PubMed
[13]
Zurück zum Zitat Cheney FW (2007) An early example of evidence-based medicine: hypoxemia due to nitrous oxide. Anesthesiology 106: 186–188PubMedCrossRef Cheney FW (2007) An early example of evidence-based medicine: hypoxemia due to nitrous oxide. Anesthesiology 106: 186–188PubMedCrossRef
[14]
Zurück zum Zitat Coppens MJ, Versichelen LF, Roily G, Mortier EP, Struys MM (2006) The mechanisms of carbon monoxide production by inhalational agents. Anaesthesia 61:462–468PubMedCrossRef Coppens MJ, Versichelen LF, Roily G, Mortier EP, Struys MM (2006) The mechanisms of carbon monoxide production by inhalational agents. Anaesthesia 61:462–468PubMedCrossRef
[15]
Zurück zum Zitat da Silva JM, Mapleson WW, Vickers MD (1997) Quantitative study of Lowe's square-root-of-time method of closed-system anaesthesia. Br J Anaesth 79:103–112PubMedCrossRef da Silva JM, Mapleson WW, Vickers MD (1997) Quantitative study of Lowe's square-root-of-time method of closed-system anaesthesia. Br J Anaesth 79:103–112PubMedCrossRef
[16]
Zurück zum Zitat Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (2008) Empfehlung zur Therapie der malignen Hyperthermie. Anästh Intensivmed 49:483–488 Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (2008) Empfehlung zur Therapie der malignen Hyperthermie. Anästh Intensivmed 49:483–488
[17]
Zurück zum Zitat Eger E, Eisenkraft J, Weiskopf R (2003) History of modern inhaled anesthetics. The Pharmacology of inhaled anesthetics. Library of Congress number:TXVI-035635, San Francisco Eger E, Eisenkraft J, Weiskopf R (2003) History of modern inhaled anesthetics. The Pharmacology of inhaled anesthetics. Library of Congress number:TXVI-035635, San Francisco
[18]
Zurück zum Zitat Eger EI, lonescu P, Laster MJ, Weiskopf RB (1997) Baralyme dehydration increases and soda lime dehydration decreases the concentration of compound A resulting from sevoflurane degradation in a standard anesthetic circuit. Anesth Analg 85: 892–898PubMed Eger EI, lonescu P, Laster MJ, Weiskopf RB (1997) Baralyme dehydration increases and soda lime dehydration decreases the concentration of compound A resulting from sevoflurane degradation in a standard anesthetic circuit. Anesth Analg 85: 892–898PubMed
[19]
Zurück zum Zitat Fang ZX, Eger El (1995) Factors affecting the concentration of compound A resulting from the degradation of sevoflurane by soda lime and Baralyme in a standard anesthetic circuit. Anesth Analg 81:564–568PubMed Fang ZX, Eger El (1995) Factors affecting the concentration of compound A resulting from the degradation of sevoflurane by soda lime and Baralyme in a standard anesthetic circuit. Anesth Analg 81:564–568PubMed
[20]
Zurück zum Zitat Fang ZX, Eger EI, Laster MJ et al. (1995) Carbon monoxide production from degradation of desflurane, enflurane, isoflurane, halothane, and sevoflurane by soda lime and Baralyme. Anesth Analg 80:1187–1193PubMed Fang ZX, Eger EI, Laster MJ et al. (1995) Carbon monoxide production from degradation of desflurane, enflurane, isoflurane, halothane, and sevoflurane by soda lime and Baralyme. Anesth Analg 80:1187–1193PubMed
[21]
Zurück zum Zitat Fang ZX, Kandel L, Laster MJ, lonescu P, Eger El (1996) Factors affecting production of compound A from the interaction of sevoflurane with Baralyme and soda lime. Anesth Analg 82: 775–781PubMed Fang ZX, Kandel L, Laster MJ, lonescu P, Eger El (1996) Factors affecting production of compound A from the interaction of sevoflurane with Baralyme and soda lime. Anesth Analg 82: 775–781PubMed
[22]
Zurück zum Zitat Fleming P, Walker PO, Priest JR (1988) Bleomycin therapy: a contraindication to the use of nitrous oxide-oxygen psychosedation in the dental office. Pediatr Dent 10:345–346PubMed Fleming P, Walker PO, Priest JR (1988) Bleomycin therapy: a contraindication to the use of nitrous oxide-oxygen psychosedation in the dental office. Pediatr Dent 10:345–346PubMed
[23]
Zurück zum Zitat Funk W, Gruber M, Wild K, Hobbhahn J (1999) Dry soda lime markedly degrades sevoflurane during simulated inhalation induction. Br J Anaesth 82:193–198PubMedCrossRef Funk W, Gruber M, Wild K, Hobbhahn J (1999) Dry soda lime markedly degrades sevoflurane during simulated inhalation induction. Br J Anaesth 82:193–198PubMedCrossRef
[24]
Zurück zum Zitat Gabrielsen J, Valentin N (1982) Routine induction of anaesthesia with thiopental and suxamethonium: apnoea without ventilation? Acta Anaesthesiol Scand 26:59–62PubMedCrossRef Gabrielsen J, Valentin N (1982) Routine induction of anaesthesia with thiopental and suxamethonium: apnoea without ventilation? Acta Anaesthesiol Scand 26:59–62PubMedCrossRef
[25]
Zurück zum Zitat Gan TJ (2006) Risk factors for postoperative nausea and vomiting. Anesth Analg 102:1884–1898PubMedCrossRef Gan TJ (2006) Risk factors for postoperative nausea and vomiting. Anesth Analg 102:1884–1898PubMedCrossRef
[26]
Zurück zum Zitat Härtung E, Anetseder M, Olthoff D et al. (1998) [Regional distribution of predisposition to maligant hyperthermia in Germany: täte in 1997]. Anasthesiol Intensivmed Notfallmed Schmerzther 33:238–242PubMedCrossRef Härtung E, Anetseder M, Olthoff D et al. (1998) [Regional distribution of predisposition to maligant hyperthermia in Germany: täte in 1997]. Anasthesiol Intensivmed Notfallmed Schmerzther 33:238–242PubMedCrossRef
[27]
Zurück zum Zitat Herff H, Paal P, Lindner KH et al. (2008) [Fatalities due to nitrous oxide. Complications from mistakes in nitrous oxide supply]. Anaesthesist 57:1006–1010PubMedCrossRef Herff H, Paal P, Lindner KH et al. (2008) [Fatalities due to nitrous oxide. Complications from mistakes in nitrous oxide supply]. Anaesthesist 57:1006–1010PubMedCrossRef
[28]
Zurück zum Zitat Herff H, Paal P, Lindner KH, Keller C, Wenzel V (2007) Fatal errors in nitrous oxide delivery. Anaesthesia 62:1202–1206PubMedCrossRef Herff H, Paal P, Lindner KH, Keller C, Wenzel V (2007) Fatal errors in nitrous oxide delivery. Anaesthesia 62:1202–1206PubMedCrossRef
[29]
Zurück zum Zitat Hoenemann CW, Halene-HoltgraeveTB, Booke M et al. (2003) Delayed onset of malignant hyperthermia in desflurane anesthesia. Anesth Analg 96:165–167PubMed Hoenemann CW, Halene-HoltgraeveTB, Booke M et al. (2003) Delayed onset of malignant hyperthermia in desflurane anesthesia. Anesth Analg 96:165–167PubMed
[30]
Zurück zum Zitat Honemann CW, Hahnenkamp K, Mollhoff T, Baum JA (2001) Minimal-flow anaesthesia with controlled ventilation: comparison between laryngeal mask airway and endotracheal tube. Eur J Anaesthesiol 18:458–466PubMed Honemann CW, Hahnenkamp K, Mollhoff T, Baum JA (2001) Minimal-flow anaesthesia with controlled ventilation: comparison between laryngeal mask airway and endotracheal tube. Eur J Anaesthesiol 18:458–466PubMed
[31]
Zurück zum Zitat Horn EP (2002) [Reduction by half of wound infection rate after colon surgery through increase of inspirational oxygen concentration from 30% to 80%]. Anasthesiol Intensivmed Notfallmed Schmerzther 37:56–57PubMedCrossRef Horn EP (2002) [Reduction by half of wound infection rate after colon surgery through increase of inspirational oxygen concentration from 30% to 80%]. Anasthesiol Intensivmed Notfallmed Schmerzther 37:56–57PubMedCrossRef
[32]
Zurück zum Zitat Jurkat-Rott K, McCarthy T, Lehmann-Horn F (2000) Genetics and pathogenesis of malignant hyperthermia. Muscle Nerve 23:4–17PubMedCrossRef Jurkat-Rott K, McCarthy T, Lehmann-Horn F (2000) Genetics and pathogenesis of malignant hyperthermia. Muscle Nerve 23:4–17PubMedCrossRef
[33]
Zurück zum Zitat Kleemann PP (1990) The climatisation of anesthetic gases under conditions of high flow to low flow. Acta Anaesthesiol Belg 41: 189–200PubMed Kleemann PP (1990) The climatisation of anesthetic gases under conditions of high flow to low flow. Acta Anaesthesiol Belg 41: 189–200PubMed
[34]
Zurück zum Zitat Kleemann PP (1994) Humidity of anaesthetic gases with respect to low flow anaesthesia. Anaesth Intensive Care 22:396–408PubMed Kleemann PP (1994) Humidity of anaesthetic gases with respect to low flow anaesthesia. Anaesth Intensive Care 22:396–408PubMed
[35]
Zurück zum Zitat Kleemann PP (1995) [Improved climatization of anesthetic gases by modifying the Sulla 808 V anesthesia equipment]. Anaesthesiol Reanim 20:71–75PubMed Kleemann PP (1995) [Improved climatization of anesthetic gases by modifying the Sulla 808 V anesthesia equipment]. Anaesthesiol Reanim 20:71–75PubMed
[36]
Zurück zum Zitat Neumann MA, Laster MJ, Weiskopf RB et al. (1999) The elimination of sodium and potassium hydroxides from desiccated soda lime diminishes degradation of desflurane to carbon monoxide and sevoflurane to compound A but does not compromise carbon dioxide absorption. Anesth Analg 89:768–773PubMed Neumann MA, Laster MJ, Weiskopf RB et al. (1999) The elimination of sodium and potassium hydroxides from desiccated soda lime diminishes degradation of desflurane to carbon monoxide and sevoflurane to compound A but does not compromise carbon dioxide absorption. Anesth Analg 89:768–773PubMed
[37]
Zurück zum Zitat Norris MC, Dewan DM (1985) Preoxygenation for cesarean section: a comparison of two techniques. Anesthesiology 62: 827–829PubMedCrossRef Norris MC, Dewan DM (1985) Preoxygenation for cesarean section: a comparison of two techniques. Anesthesiology 62: 827–829PubMedCrossRef
[38]
Zurück zum Zitat Nost R, Thiel-Ritter A, Scholz S, Hempelmann G, Muller M (2008) Balanced anesthesia with remifentanil and desflurane: clinical considerations for dose adjustment in adults. J Opioid Manag 4: 305–309PubMed Nost R, Thiel-Ritter A, Scholz S, Hempelmann G, Muller M (2008) Balanced anesthesia with remifentanil and desflurane: clinical considerations for dose adjustment in adults. J Opioid Manag 4: 305–309PubMed
[39]
Zurück zum Zitat Oczenski W, Schwarz S, Fitzgerald RD (2004) Vital capacity manoeuvre in general anaesthesia: useful or useless? Eur J Anaesthesiol 21:253–259PubMed Oczenski W, Schwarz S, Fitzgerald RD (2004) Vital capacity manoeuvre in general anaesthesia: useful or useless? Eur J Anaesthesiol 21:253–259PubMed
[40]
Zurück zum Zitat Punjasawadwong Y, Boonjeungmonkol N, Phongchiewboon A (2007) Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev CD003843 Punjasawadwong Y, Boonjeungmonkol N, Phongchiewboon A (2007) Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev CD003843
[41]
Zurück zum Zitat Quadan M, Akca O, Mahid SS, Hornung CA, Polk HC (2009) Perioperative supplemental oxygen therapy and surgical site infekction: a meta-analysis of randomized controlled trials. Arch Surg 144:359–366CrossRef Quadan M, Akca O, Mahid SS, Hornung CA, Polk HC (2009) Perioperative supplemental oxygen therapy and surgical site infekction: a meta-analysis of randomized controlled trials. Arch Surg 144:359–366CrossRef
[42]
Zurück zum Zitat Reinoso-Barbero F, Martinez-Garcia E, Hernandez-Gancedo MC, Simon AM (2006) The effect of epidural bupivacaine on maintenance requirements of sevoflurane evaluated by bispectral index in children. Eur J Anaesthesiol 23:460–464PubMedCrossRef Reinoso-Barbero F, Martinez-Garcia E, Hernandez-Gancedo MC, Simon AM (2006) The effect of epidural bupivacaine on maintenance requirements of sevoflurane evaluated by bispectral index in children. Eur J Anaesthesiol 23:460–464PubMedCrossRef
[43]
Zurück zum Zitat Rosenberg H, Davis M, James D, Pollock N, Stowell K (2007) Malignant hyperthermia. Orphanet J Rare Dis 2:21PubMedCrossRef Rosenberg H, Davis M, James D, Pollock N, Stowell K (2007) Malignant hyperthermia. Orphanet J Rare Dis 2:21PubMedCrossRef
[44]
Zurück zum Zitat Shane SM, Ashman H (1952) A clinical study of a balanced anesthesia mixture; report of 10,000 cases. South Med J 45:591–595PubMedCrossRef Shane SM, Ashman H (1952) A clinical study of a balanced anesthesia mixture; report of 10,000 cases. South Med J 45:591–595PubMedCrossRef
[45]
Zurück zum Zitat Shanks CA, Fragen RJ, Ling D (1993) Continuous intravenous infusion of rocuronium (ORG 9426) in patients receiving balanced, enflurane, or isoflurane anesthesia. Anesthesiology 78:649–651PubMedCrossRef Shanks CA, Fragen RJ, Ling D (1993) Continuous intravenous infusion of rocuronium (ORG 9426) in patients receiving balanced, enflurane, or isoflurane anesthesia. Anesthesiology 78:649–651PubMedCrossRef
[46]
Zurück zum Zitat Steffey EP, Laster MJ, lonescu P (1997) Dehydration of Baralyme increases compound A resulting from sevoflurane degradation in a standard anesthetic circuit used to anesthetize swine. Anesth Analg 85:1382–1386PubMed Steffey EP, Laster MJ, lonescu P (1997) Dehydration of Baralyme increases compound A resulting from sevoflurane degradation in a standard anesthetic circuit used to anesthetize swine. Anesth Analg 85:1382–1386PubMed
[47]
[48]
Zurück zum Zitat Tziavrangos E, Schug SA (2006) Regional anaesthesia and peri-operative outcome. Curr Opin Anaesthesiol 19:521–525PubMedCrossRef Tziavrangos E, Schug SA (2006) Regional anaesthesia and peri-operative outcome. Curr Opin Anaesthesiol 19:521–525PubMedCrossRef
[49]
Zurück zum Zitat Van AH, Van HJ, Merckx L, Mollhoff T, Mulier J, Lubbesmeyer HJ (1990) [Total intravenous anesthesia using propofol and alfentanil in comparison with balanced anesthesia in neurosurgery]. Anasth Intensivther Notfallmed 25:54–58CrossRef Van AH, Van HJ, Merckx L, Mollhoff T, Mulier J, Lubbesmeyer HJ (1990) [Total intravenous anesthesia using propofol and alfentanil in comparison with balanced anesthesia in neurosurgery]. Anasth Intensivther Notfallmed 25:54–58CrossRef
[50]
Zurück zum Zitat Waters RM (1924) Clinical Scope and Utility of Carbon Dioxid Filtration in Inhalation Anaesthesia. Anesth Analg 1924:20–22 Waters RM (1924) Clinical Scope and Utility of Carbon Dioxid Filtration in Inhalation Anaesthesia. Anesth Analg 1924:20–22
[51]
Zurück zum Zitat Waterson CK (1984) Recovery of waste anesthetic gases. In: Brown BR (ed.) Future Anesthesia Delivery Sytems. Contemporary Anesthesia Practice, Vol. VIII. Davis, Philadelphia Waterson CK (1984) Recovery of waste anesthetic gases. In: Brown BR (ed.) Future Anesthesia Delivery Sytems. Contemporary Anesthesia Practice, Vol. VIII. Davis, Philadelphia
[52]
Metadaten
Titel
Balancierte Anästhesie
verfasst von
Dr. Christian Hönemann
Copyright-Jahr
2011
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-540-79156-0_15

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.