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Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54(10): 604-615
DOI: 10.1055/a-0720-3880
Topthema
Georg Thieme Verlag KG Stuttgart · New York

Einleitung des nicht nüchternen Patienten: Welche Medikamente sind zu verwenden?

Rapid Sequence Induction – Which Medication Should Be Used?
Christiane G. Stäuble
,
Manfred Blobner
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Publikationsverlauf

Publikationsdatum:
22. Oktober 2019 (online)

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Zusammenfassung

Die Rapid Sequence Induction beschreibt ein nicht evidenzbasiertes Anästhesieverfahren zur Narkoseeinleitung bei nicht nüchternen Patienten. Ziel dieser Einleitungstechnik ist es, den anästhesierten Patienten ohne Zwischenbeatmung zügig endotracheal zu intubieren, um das Risiko für eine Aspiration zu minimieren. Der Beitrag gibt Empfehlungen für das anästhesiologische Management nicht nüchterner Patienten und verweist insbesondere auf die für die RSI benötigten Medikamente.

Abstract

The rapid sequence induction (RSI) is a not evidence-based technique designed to minimize the chance of pulmonary aspiration in high-risk patients requiring general anesthesia. Primary aim of this anesthetic technique is, therefore, a fast airway protection with an endotracheal tube to reduce the chance of passive or active regurgitation. This article discusses the anesthetic management of patients with an increased risk of aspiration, and, particularly, refers to the medications required for RSI.

Kernaussagen

  • Die Rapid Sequence Induction (RSI) ist ein nicht evidenzbasiertes Verfahren zur Narkoseeinleitung bei nicht nüchternen Patienten sowie Patienten mit (Sub-)Ileus, Erbrechen und bestimmten anderen Erkrankungen sowie Schwangeren.

  • Oberstes Ziel dieser Einleitungstechnik ist es, den anästhesierten Patienten ohne Maskenbeatmung zügig zu intubieren, um das Risiko für eine pulmonale Aspiration zu minimieren. Entscheidend ist das Zeitfenster zwischen dem Verlust der Schutzreflexe und der endotrachealen Intubation, da in diesem Intervall das größte Aspirationsrisiko besteht.

  • Zur Einleitung kommen i. d. R. kurzwirksame Opioide wie Alfentanil und Remifentanil zur Anwendung.

  • Bei einer RSI zur Sectio caesarea wird vor Abnabelung des Kindes auf Opioide üblicherweise verzichtet. Nach Abnabelung des Kindes werden Opioide zur Analgesie empfohlen.

  • Opioide in Kombination mit Rocuronium schaffen Intubationsbedingungen, die denen nach Succinylcholin-Gabe vergleichbar sind.

  • Propofol supprimiert laryngeale und pharyngeale Reflexe effektiv und ist deshalb gut zur RSI geeignet. In Abhängigkeit vom präoperativen kardialen Status gibt es Alternativen wie das weniger kardiodepressiv wirkende Thiopental.

  • Auch während der Narkoseausleitung können gravierende Atemwegsprobleme mit der Möglichkeit einer Aspiration auftreten.

Schlüsselwörter

Blitzeinleitung - präoperative Nüchternheit - pulmonale Aspiration - Hypnotika - Muskelrelaxanzien

Key words

rapid sequence induction - preoperative fasting - pulmonary aspiration - hypnotics - neuromuscular blocking agents
 

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