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01.10.2011 | Regionalanästhesie

Kardioprotektion durch thorakale Periduralanästhesie?

Metaanalyse

verfasst von: PD. Dr. A. Gauss, S.K. Jahn, L.H.J. Eberhart, W. Stahl, M. Rockemann, M. Georgieff, F. Wagner, R. Meierhenrich

Erschienen in: Die Anaesthesiologie | Ausgabe 10/2011

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Zusammenfassung

Hintergrund

Bislang wird vermutet, dass der Einsatz einer thorakalen Periduralanästhesie (PDA) bei nichtherzchirurgischen Operationen kardioprotektive Effekte bietet. Zwei frühere Metaanalysen ergaben kontroverse Ergebnisse zum Einfluss einer PDA auf das Überleben. Ziel der aktuellen Metaanalyse auf der Basis prospektiver Studien war die Klärung der Frage, ob die thorakale PDA die kardiale Morbidität oder die Mortalität reduziert.

Material und Methoden

Es wurde eine systematische Literatursuche, basierend auf medizinischen Datenbanken (Medline, EBM-Reviews, Embase, Biosis und Biological Abstracts) durchgeführt. Relevante Studien wurden von 2 unabhängigen Untersuchern evaluiert. In die Metaanalyse wurden bis Ende 2008 publizierte randomisierte Studien mit der Frage des Einflusses einer thorakalen PDA auf das „outcome“ bei nichtherzchirurgischen Operationen eingeschlossen. Die Berechnungen erfolgten mit dem Statistikprogramm Review-Manager 4.1 unter Annahme fixer Effekte („fixed effects model“).

Ergebnisse

Es wurden 9 Studien mit 2768 Patienten in die Metaanalyse aufgenommen. Die thorakale PDA reduzierte die postoperative Mortalität nicht [“odds ratio“ (Peto OR): 1,08; 95%-Konfidenzintervall (95%-KI) 0,74–1,58]. Die Myokardinfarktrate wurde nur tendenziell, aber nicht signifikant gesenkt (Peto OR: 0,65; 95%-KI 0,4–1,05).

Schlussfolgerung

Aufgrund der vorliegenden Metaanalyse ergibt sich kein Hinweis, dass durch die thorakale PDA die perioperative Mortalität bei nichtherzchirurgischen Eingriffen gesenkt werden kann. Ein günstiger Effekt auf die Myokardinfarktrate bleibt weiterhin fraglich.

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Titel: Kardioprotektion durch thorakale Periduralanästhesie?
Metaanalyse
verfasst von: PD. Dr. A. Gauss
S.K. Jahn
L.H.J. Eberhart
W. Stahl
M. Rockemann
M. Georgieff
F. Wagner
R. Meierhenrich
Publikationsdatum: 01.10.2011
Verlag: Springer-Verlag
Erschienen in: Die Anaesthesiologie / Ausgabe 10/2011
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI: https://doi.org/10.1007/s00101-011-1941-9

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Kardioprotektion durch thorakale Periduralanästhesie?

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