Anästhesie bei Erwachsenen mit Adipositas

Zusammenfassung

Die Prävalenz der Adipositas hat in den letzten 10 Jahren weltweit erheblich zugenommen – deshalb wird die perioperative Versorgung auch extrem adipöser Patienten immer häufiger notwendig werden. Dies schließt medizinische, technische und organisatorische Aspekte ein. Dieser Beitrag fasst neue Erkenntnisse und Empfehlungen zur Anästhesie bei Adipositas zusammen.

Abstract

The prevalence of obesity has substantially increased worldwide during the last ten years. Hence, more anaesthetic procedures will be performed in obese patients in the future and more hospitals have to be prepared for the perioperative treatment of extremely obese patients including medical, technical and organisational issues. These include not only the management of the perioperative problems of adiposity, but also of its numerous concomitant diseases. Besides hyperlipidemia, diabetes mellitus, arterial hypertension and coronary heart disease, the obstructive sleep-apnea syndrome (OSAS) challenges the available equipment and the staff involved. Airway and breathing problems are very frequent and regional anaesthesia should be preferred. If general anaesthesia is indicated, short acting drugs like desflurane or remifentanil are recommended. Preoxygenation is improved by continuous positive airway pressure (CPAP). In this educational review, a summary of the currently known facts regarding anaesthesia in obese patients is outlined together with future perspectives. Regional anaesthesia is also recommended for postoperative pain therapy.

Kernaussagen

• Die Prävalenz der Adipositas hat in den letzten 10 Jahren auch in Deutschland weiter zugenommen.

• Hypertonie, Fettstoffwechselstörungen, Diabetes mellitus, kardiovaskuläre Erkrankungen und Schlafapnoe-Syndrom sind Folge- und Begleiterkrankungen der Adipositas.

• Die perioperative Betreuung adipöser Patienten erfordert spezielle räumliche, apparative und personelle Voraussetzungen.

• Probleme mit Atemwegsmanagement, Atmung und Monitoring sind bei Adipositas relativ häufig.

• Regionalanästhesiologische Verfahren sollten bevorzugt eingesetzt werden.

• Kurzwirksame Substanzen wie Desfluran und Remifentanil sind zu bevorzugen.

• Die Präoxygenierung wird durch umgekehrte Trendelenburg-Lagerung und Unterstützung der Atmung mit kontinuierlichem positivem Atemwegsdruck effektiver.

• Auch in der postoperativen Schmerztherapie sind Regionalanästhesieverfahren zu bevorzugen.

Schlüsselwörter

Adipositas - Anästhesie - Schlafapnoe-Syndrom

Key words

obesity - anaesthesia - obstructive sleep apnea syndrome

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