Der demenzkranke Patient – Was ist beim anästhesiologischen Management zu beachten?

Thomas Frietsch; Matthias Schuler; Georg Adler

doi:10.1055/s-0034-1373800

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, Table of Contents

Anästhesiol Intensivmed Notfallmed Schmerzther 2014; 49(4): 220-229
DOI: 10.1055/s-0034-1373800

Fachwissen

Anästhesiologie

Der demenzkranke Patient – Was ist beim anästhesiologischen Management zu beachten?

Anaesthesiological management of patients with dementia

Authors

Thomas Frietsch
Matthias Schuler
Georg Adler

Abstract

Zusammenfassung

Aus der Alterung der Gesellschaft erklärt sich, dass Patienten mit demenziellen Erkrankungen dem Anästhesisten immer häufiger begegnen. Die Patienten und Angehörigen sind darüber besorgt, dass Anästhesie eine bestehende Demenz aggraviert oder eine postoperative Demenz (POD) hervorrufen kann. Von einigen üblichen volatilen Hypnotika und auch von Propofol ist im Tierversuch nachgewiesen worden, dass sie die Konzentration der mit einer Demenz verknüpften Proteine Tau und Beta-Amyloid im Liquor erhöhen. Die perioperativen Komplikationen kognitive Dysfunktion und Delir dieses speziellen Kollektivs treten vergleichsweise häufiger auf als in der Normalbevölkerung. Es scheint aus anästhesiologischer Sicht wichtig, regelhaft die Erkrankung Demenz präoperativ zu erfassen, um Narkoseführung und Monitoring intra- und postoperativ darauf abstimmen zu können. Zu dem interagieren Antidementiva wie Azetylcholinesterasehemmer und andere neurotrope Medikamente mit den routinemäßige in gesetzten Anästhetika.

Generell ist bei Menschen mit Demenz die kognitive Beeinträchtigung von Konzentration, Erinnerung, Informationsverarbeitung, Sprachverständnis und soziale Anpassungsfähigkeit anzunehmen und im perioperativen Management zu berücksichtigen. Diese Übersicht soll den gegenwärtigen Stand der wissenschaftlichen Kenntnisse zum Thema zusammentragen und ihn zu Empfehlungen zum perioperativen Management dieser Patenten entwickeln.

Abstract

The aging society challenges anaesthesiologists with a growing number of patients with dementia. These and their relatives worry about an aggravation of an already existing dementia or even the postoperative evocation of one. Common volatile anaesthetics and propofol are suspected to increase dementia – associated protein tau and amyloid-betalevels in the brain. Perioperative complications such as cognitive dysfunction and delirium occur more frequently in dementia patients. For anaesthesiologists, it seems prudent toassess the grade of dementia in the elderly to adjust anaesthesia drug doses and monitoring intra- and postoperatively. Pharmacological interactions with antidementic andneuroleptic current medications affectanaesthetic and analgesic effects.In dementia, perioperative malfunction of cognition, memory, attention, information processing, communication and social interaction abilities is of profound influence on the perioperative management.

This review mentions actual knowledge about dementia forms and symptoms in brief. Recommendations for the anaesthesia care are given in more detail.

Schlüsselwörter:

Demenztypisierung - Prämedikation des Demenzkranken - Schmerztherapie bei demenziellen Erkrankungen - Narkoseführung beim Dementen - POCD - Delir - postoperative Demenz

Key words:

dementia type - preassessment of dementia patients - pain therapy in dementedpatients - anaesthesia management for dementia - POCD - delirium - postoperative dementia

Full Text

References

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