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Erschienen in: Der Anaesthesist 5/2016

01.05.2016 | Hypoxämie | CME

Anästhesie in der Thoraxchirurgie

verfasst von: Dr. T. Kammerer, E. Speck, V. von Dossow

Erschienen in: Die Anaesthesiologie | Ausgabe 5/2016

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Zusammenfassung

Thorakale Eingriffe stellen eine besondere Herausforderung für die Anästhesie dar und erfordern häufig hohe personelle und materielle Ressourcen. Genaue Kenntnisse der Pathophysiologie sind essenziell für die Wahl des Narkoseverfahrens, die Lungenseparation, die Überwachung und Behandlung der Hämodynamik und die postoperative Nachbetreuung. Die zunehmende Zahl thorakaler Eingriffe sowie die häufig komplex erkrankten Patienten erfordern die enge interdisziplinäre Zusammenarbeit zwischen Chirurgen, Anästhesiologen und Intensivmedizinern. Besonderes Augenmerk gilt neben den anästhesiologischen Techniken der Vermeidung von perioperativen Komplikationen, die das Outcome der Patienten relevant beeinflussen können. Insbesondere Hypoxämien unter Einlungenventilation (ELV) beeinflussen die postoperative Morbidität und Mortalität. Die lungenprotektive Beatmung spielt eine entscheidende Rolle bei der Vermeidung eines postoperativen akuten Lungenversagens.
Literatur
1.
Zurück zum Zitat Jones NL, Edmonds L, Ghosh S et al (2013) A review of enhanced recovery for thoracic anaesthesia and surgery. Anaesthesia 68:179–189 CrossRefPubMed Jones NL, Edmonds L, Ghosh S et al (2013) A review of enhanced recovery for thoracic anaesthesia and surgery. Anaesthesia 68:179–189 CrossRefPubMed
2.
Zurück zum Zitat Shiono S, Abiko M, Sato T (2013) Postoperative complications in elderly patients after lung cancer surgery. Interact Cardiovasc Thorac Surg 16:819–823 CrossRefPubMedPubMedCentral Shiono S, Abiko M, Sato T (2013) Postoperative complications in elderly patients after lung cancer surgery. Interact Cardiovasc Thorac Surg 16:819–823 CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Chambers A, Routledge T, Pilling J et al (2010) In elderly patients with lung cancer is resection justified in terms of morbidity, mortality and residual quality of life? Interact Cardiovasc Thorac Surg 10:1015–1021 CrossRefPubMed Chambers A, Routledge T, Pilling J et al (2010) In elderly patients with lung cancer is resection justified in terms of morbidity, mortality and residual quality of life? Interact Cardiovasc Thorac Surg 10:1015–1021 CrossRefPubMed
4.
Zurück zum Zitat Liu HC, Huang WC, Wu CL et al (2013) Surgery for elderly lung cancer. Ann Thorac Cardiovasc Surg 19:416–422 CrossRefPubMed Liu HC, Huang WC, Wu CL et al (2013) Surgery for elderly lung cancer. Ann Thorac Cardiovasc Surg 19:416–422 CrossRefPubMed
5.
Zurück zum Zitat Yepes-Temiño MJ1, Monedero P, Pérez-Valdivieso JR, Grupo Español de Anestesia Toracica (2016) Risk prediction model for respiratory complications after lung resection: An observational multicentre study. Eur J Anaesthesiol. 33(5):326–333 CrossRefPubMed Yepes-Temiño MJ1, Monedero P, Pérez-Valdivieso JR, Grupo Español de Anestesia Toracica (2016) Risk prediction model for respiratory complications after lung resection: An observational multicentre study. Eur J Anaesthesiol. 33(5):326–333 CrossRefPubMed
6.
Zurück zum Zitat Mutlak H, Czerner S, Winter H et al (2010) Präoperative Evaluation und Risikoeinschätzung in der Thoraxchirurgie. Anaesthesist 59:918–928 CrossRefPubMed Mutlak H, Czerner S, Winter H et al (2010) Präoperative Evaluation und Risikoeinschätzung in der Thoraxchirurgie. Anaesthesist 59:918–928 CrossRefPubMed
7.
Zurück zum Zitat Brunelli A, Berrisford RG, Rocco G et al (2009) The European Thoracic Database project: composite performance score to measure quality of care after major lung resection. Eur J Cardiothorac Surg 35:769–774 CrossRefPubMed Brunelli A, Berrisford RG, Rocco G et al (2009) The European Thoracic Database project: composite performance score to measure quality of care after major lung resection. Eur J Cardiothorac Surg 35:769–774 CrossRefPubMed
8.
Zurück zum Zitat Brunelli A, Refai MA, Salati M et al (2006) Carbon monoxide lung diffusion capacity improves risk stratification in patients without airflow limitation: evidence for systematic measurement before lung resection. Eur J Cardiothorac Surg 29:567–570 CrossRefPubMed Brunelli A, Refai MA, Salati M et al (2006) Carbon monoxide lung diffusion capacity improves risk stratification in patients without airflow limitation: evidence for systematic measurement before lung resection. Eur J Cardiothorac Surg 29:567–570 CrossRefPubMed
9.
Zurück zum Zitat Colice GL, Shafazand S, Griffin JP et al (2007) Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2nd edition. Chest 132:161S–177S CrossRefPubMed Colice GL, Shafazand S, Griffin JP et al (2007) Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2nd edition. Chest 132:161S–177S CrossRefPubMed
10.
Zurück zum Zitat West JB, Dollery CT, Naimark A (1964) Distribution of blood flow in isolated lung; relation to vascular and alveolar pressures. J Appl Physiol 19:713–724 PubMed West JB, Dollery CT, Naimark A (1964) Distribution of blood flow in isolated lung; relation to vascular and alveolar pressures. J Appl Physiol 19:713–724 PubMed
11.
Zurück zum Zitat Glenny RW, Robertson HT (2011) Determinants of pulmonary blood flow distribution. Compr Physiol 1:39–59 PubMed Glenny RW, Robertson HT (2011) Determinants of pulmonary blood flow distribution. Compr Physiol 1:39–59 PubMed
12.
Zurück zum Zitat Lohser J (2008) Evidence-based management of one-lung ventilation. Anesthesiol Clin 26:241–272 CrossRefPubMed Lohser J (2008) Evidence-based management of one-lung ventilation. Anesthesiol Clin 26:241–272 CrossRefPubMed
13.
Zurück zum Zitat Karzai W, Haberstroh J, Priebe HJ (1998) Effects of desflurane and propofol on arterial oxygenation during one-lung ventilation in the pig. Acta Anaesthesiol Scand 42:648–652 CrossRefPubMed Karzai W, Haberstroh J, Priebe HJ (1998) Effects of desflurane and propofol on arterial oxygenation during one-lung ventilation in the pig. Acta Anaesthesiol Scand 42:648–652 CrossRefPubMed
14.
Zurück zum Zitat Rogers SN, Benumof JL (1985) Halothane and isoflurane do not decrease PaO2 during one-lung ventilation in intravenously anesthetized patients. Anesth Analg 64:946–954 CrossRefPubMed Rogers SN, Benumof JL (1985) Halothane and isoflurane do not decrease PaO2 during one-lung ventilation in intravenously anesthetized patients. Anesth Analg 64:946–954 CrossRefPubMed
15.
Zurück zum Zitat Schwarzkopf K, Schreiber T, Preussler NP et al (2003) Lung perfusion, shunt fraction, and oxygenation during one-lung ventilation in pigs: the effects of desflurane, isoflurane, and propofol. J Cardiothorac Vasc Anesth 17:73–75 CrossRefPubMed Schwarzkopf K, Schreiber T, Preussler NP et al (2003) Lung perfusion, shunt fraction, and oxygenation during one-lung ventilation in pigs: the effects of desflurane, isoflurane, and propofol. J Cardiothorac Vasc Anesth 17:73–75 CrossRefPubMed
16.
Zurück zum Zitat Ozcan PE, Senturk M, Sungur UZ et al (2007) Effects of thoracic epidural anaesthesia on pulmonary venous admixture and oxygenation during one-lung ventilation. Acta Anaesthesiol Scand 51:1117–1122 CrossRefPubMed Ozcan PE, Senturk M, Sungur UZ et al (2007) Effects of thoracic epidural anaesthesia on pulmonary venous admixture and oxygenation during one-lung ventilation. Acta Anaesthesiol Scand 51:1117–1122 CrossRefPubMed
17.
Zurück zum Zitat Dossow V Von, Welte M, Zaune U et al (2001) Thoracic epidural anesthesia combined with general anesthesia: the preferred anesthetic technique for thoracic surgery. Anesth Analg 92:848–854 CrossRef Dossow V Von, Welte M, Zaune U et al (2001) Thoracic epidural anesthesia combined with general anesthesia: the preferred anesthetic technique for thoracic surgery. Anesth Analg 92:848–854 CrossRef
18.
Zurück zum Zitat Garutti I, Quintana B, Olmedilla L et al (1999) Arterial oxygenation during one-lung ventilation: combined versus general anesthesia. Anesth Analg 88:494–499 PubMed Garutti I, Quintana B, Olmedilla L et al (1999) Arterial oxygenation during one-lung ventilation: combined versus general anesthesia. Anesth Analg 88:494–499 PubMed
19.
Zurück zum Zitat Campos JH (2003) An update on bronchial blockers during lung separation techniques in adults. Anesth Analg 97:1266–1274 CrossRefPubMed Campos JH (2003) An update on bronchial blockers during lung separation techniques in adults. Anesth Analg 97:1266–1274 CrossRefPubMed
20.
Zurück zum Zitat Brodsky JB, Macario A, Mark JB (1996) Tracheal diameter predicts double-lumen tube size: a method for selecting left double-lumen tubes. Anesth Analg 82:861–864 PubMed Brodsky JB, Macario A, Mark JB (1996) Tracheal diameter predicts double-lumen tube size: a method for selecting left double-lumen tubes. Anesth Analg 82:861–864 PubMed
21.
Zurück zum Zitat Brassard CL, Lohser J, Donati F et al (2014) Step-by-step clinical management of one-lung ventilation: continuing professional development. Can J Anaesth 61:1103–1121 CrossRefPubMed Brassard CL, Lohser J, Donati F et al (2014) Step-by-step clinical management of one-lung ventilation: continuing professional development. Can J Anaesth 61:1103–1121 CrossRefPubMed
22.
Zurück zum Zitat Hedenstierna G, Tokics L, Strandberg A et al (1986) Correlation of gas exchange impairment to development of atelectasis during anaesthesia and muscle paralysis. Acta Anaesthesiol Scand 30:183–191 CrossRefPubMed Hedenstierna G, Tokics L, Strandberg A et al (1986) Correlation of gas exchange impairment to development of atelectasis during anaesthesia and muscle paralysis. Acta Anaesthesiol Scand 30:183–191 CrossRefPubMed
23.
Zurück zum Zitat Unzueta C, Tusman G, Suarez-Sipmann F et al (2012) Alveolar recruitment improves ventilation during thoracic surgery: a randomized controlled trial. Br J Anaesth 108:517–524 CrossRefPubMed Unzueta C, Tusman G, Suarez-Sipmann F et al (2012) Alveolar recruitment improves ventilation during thoracic surgery: a randomized controlled trial. Br J Anaesth 108:517–524 CrossRefPubMed
24.
Zurück zum Zitat Karzai W, Schwarzkopf K (2009) Hypoxemia during one-lung ventilation: prediction, prevention, and treatment. Anesthesiology 110:1402–1411 CrossRefPubMed Karzai W, Schwarzkopf K (2009) Hypoxemia during one-lung ventilation: prediction, prevention, and treatment. Anesthesiology 110:1402–1411 CrossRefPubMed
25.
Zurück zum Zitat Kazan R, Bracco D, Hemmerling TM (2009) Reduced cerebral oxygen saturation measured by absolute cerebral oximetry during thoracic surgery correlates with postoperative complications. Br J Anaesth 103:811–816 CrossRefPubMed Kazan R, Bracco D, Hemmerling TM (2009) Reduced cerebral oxygen saturation measured by absolute cerebral oximetry during thoracic surgery correlates with postoperative complications. Br J Anaesth 103:811–816 CrossRefPubMed
26.
Zurück zum Zitat Tang L, Kazan R, Taddei R et al (2012) Reduced cerebral oxygen saturation during thoracic surgery predicts early postoperative cognitive dysfunction. Br J Anaesth 108:623–629 CrossRefPubMed Tang L, Kazan R, Taddei R et al (2012) Reduced cerebral oxygen saturation during thoracic surgery predicts early postoperative cognitive dysfunction. Br J Anaesth 108:623–629 CrossRefPubMed
27.
28.
Zurück zum Zitat Szegedi LL, D’hollander AA, Vermassen FE et al (2010) Gravity is an important determinant of oxygenation during one-lung ventilation. Acta Anaesthesiol Scand 54:744–750 CrossRefPubMed Szegedi LL, D’hollander AA, Vermassen FE et al (2010) Gravity is an important determinant of oxygenation during one-lung ventilation. Acta Anaesthesiol Scand 54:744–750 CrossRefPubMed
29.
Zurück zum Zitat Beck KC, Rehder K (1986) Differences in regional vascular conductances in isolated dog lungs. J Appl Physiol 61:530–538 PubMed Beck KC, Rehder K (1986) Differences in regional vascular conductances in isolated dog lungs. J Appl Physiol 61:530–538 PubMed
30.
Zurück zum Zitat Lumb AB, Slinger P (2015) Hypoxic pulmonary vasoconstriction: physiology and anesthetic implications. Anesthesiology 122:932–946 CrossRefPubMed Lumb AB, Slinger P (2015) Hypoxic pulmonary vasoconstriction: physiology and anesthetic implications. Anesthesiology 122:932–946 CrossRefPubMed
31.
Zurück zum Zitat Tusman G, Bohm SH, Sipmann FS et al (2004) Lung recruitment improves the efficiency of ventilation and gas exchange during one-lung ventilation anesthesia. Anesth Analg 98:1604–1609 CrossRefPubMed Tusman G, Bohm SH, Sipmann FS et al (2004) Lung recruitment improves the efficiency of ventilation and gas exchange during one-lung ventilation anesthesia. Anesth Analg 98:1604–1609 CrossRefPubMed
32.
Zurück zum Zitat Russell WJ (2009) Intermittent positive airway pressure to manage hypoxia during one-lung anaesthesia. Anaesth Intensive Care 37:432–434 PubMed Russell WJ (2009) Intermittent positive airway pressure to manage hypoxia during one-lung anaesthesia. Anaesth Intensive Care 37:432–434 PubMed
33.
Zurück zum Zitat Ku CM, Slinger P, Waddell TK (2009) A novel method of treating hypoxemia during one-lung ventilation for thoracoscopic surgery. J Cardiothorac Vasc Anesth 23:850–852 CrossRefPubMed Ku CM, Slinger P, Waddell TK (2009) A novel method of treating hypoxemia during one-lung ventilation for thoracoscopic surgery. J Cardiothorac Vasc Anesth 23:850–852 CrossRefPubMed
34.
Zurück zum Zitat Ender J, Brodowsky M, Falk V et al (2010) High-frequency jet ventilation as an alternative method compared to conventional one-lung ventilation using double-lumen tubes during minimally invasive coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 24:602–607 CrossRefPubMed Ender J, Brodowsky M, Falk V et al (2010) High-frequency jet ventilation as an alternative method compared to conventional one-lung ventilation using double-lumen tubes during minimally invasive coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 24:602–607 CrossRefPubMed
35.
Zurück zum Zitat Schwarzkopf K, Klein U, Schreiber T et al (2001) Oxygenation during one-lung ventilation: the effects of inhaled nitric oxide and increasing levels of inspired fraction of oxygen. Anesth Analg 92:842–847 CrossRefPubMed Schwarzkopf K, Klein U, Schreiber T et al (2001) Oxygenation during one-lung ventilation: the effects of inhaled nitric oxide and increasing levels of inspired fraction of oxygen. Anesth Analg 92:842–847 CrossRefPubMed
36.
Zurück zum Zitat Liu R, Evgenov OV, Ichinose F (2005) NOS3 deficiency augments hypoxic pulmonary vasoconstriction and enhances systemic oxygenation during one-lung ventilation in mice. J Appl Physiol 98:748–752 CrossRefPubMed Liu R, Evgenov OV, Ichinose F (2005) NOS3 deficiency augments hypoxic pulmonary vasoconstriction and enhances systemic oxygenation during one-lung ventilation in mice. J Appl Physiol 98:748–752 CrossRefPubMed
37.
Zurück zum Zitat Silva-Costa-Gomes T, Gallart L, Valles J et al (2005) Low- vs high-dose almitrine combined with nitric oxide to prevent hypoxia during open-chest one-lung ventilation. Br J Anaesth 95:410–416 CrossRefPubMed Silva-Costa-Gomes T, Gallart L, Valles J et al (2005) Low- vs high-dose almitrine combined with nitric oxide to prevent hypoxia during open-chest one-lung ventilation. Br J Anaesth 95:410–416 CrossRefPubMed
38.
Zurück zum Zitat Torbic H, Szumita PM, Anger KE et al (2013) Inhaled epoprostenol vs inhaled nitric oxide for refractory hypoxemia in critically ill patients. J Crit Care 28:844–848 CrossRefPubMed Torbic H, Szumita PM, Anger KE et al (2013) Inhaled epoprostenol vs inhaled nitric oxide for refractory hypoxemia in critically ill patients. J Crit Care 28:844–848 CrossRefPubMed
39.
Zurück zum Zitat Pacheco J, Arnold H, Skrupky L et al (2014) Predictors of outcome in 216 subjects with ARDS treated with inhaled epoprostenol. Respir Care 59:1178–1185 CrossRefPubMed Pacheco J, Arnold H, Skrupky L et al (2014) Predictors of outcome in 216 subjects with ARDS treated with inhaled epoprostenol. Respir Care 59:1178–1185 CrossRefPubMed
40.
Zurück zum Zitat Tabrizi MB, Schinco MA, Tepas JJ 3rd et al (2012) Inhaled epoprostenol improves oxygenation in severe hypoxemia. J Trauma Acute Care Surg 73:503–506 CrossRefPubMed Tabrizi MB, Schinco MA, Tepas JJ 3rd et al (2012) Inhaled epoprostenol improves oxygenation in severe hypoxemia. J Trauma Acute Care Surg 73:503–506 CrossRefPubMed
41.
Zurück zum Zitat Raghunathan K, Connelly NR, Robbins LD et al (2010) Inhaled epoprostenol during one-lung ventilation. Ann Thorac Surg 89:981–983 CrossRefPubMed Raghunathan K, Connelly NR, Robbins LD et al (2010) Inhaled epoprostenol during one-lung ventilation. Ann Thorac Surg 89:981–983 CrossRefPubMed
42.
Zurück zum Zitat Machuca TN, Collaud S, Mercier O et al (2015) Outcomes of intraoperative extracorporeal membrane oxygenation versus cardiopulmonary bypass for lung transplantation. J Thorac Cardiovasc Surg 149:1152–1157 CrossRefPubMed Machuca TN, Collaud S, Mercier O et al (2015) Outcomes of intraoperative extracorporeal membrane oxygenation versus cardiopulmonary bypass for lung transplantation. J Thorac Cardiovasc Surg 149:1152–1157 CrossRefPubMed
43.
Zurück zum Zitat Powell ES, Cook D, Pearce AC et al (2011) A prospective, multicentre, observational cohort study of analgesia and outcome after pneumonectomy. Br J Anaesth 106:364–370 CrossRefPubMed Powell ES, Cook D, Pearce AC et al (2011) A prospective, multicentre, observational cohort study of analgesia and outcome after pneumonectomy. Br J Anaesth 106:364–370 CrossRefPubMed
44.
Zurück zum Zitat Douglas CG, Haldane JS (1922) The regulation of the general circulation rate in man. J Physiology 56:69–100 CrossRef Douglas CG, Haldane JS (1922) The regulation of the general circulation rate in man. J Physiology 56:69–100 CrossRef
Metadaten
Titel
Anästhesie in der Thoraxchirurgie
verfasst von
Dr. T. Kammerer
E. Speck
V. von Dossow
Publikationsdatum
01.05.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Anaesthesiologie / Ausgabe 5/2016
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI
https://doi.org/10.1007/s00101-016-0173-4

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