Einleitung von nicht nüchternen Patienten am Beispiel von Schwangeren und Kindern

Zusammenfassung

Die klassische Technik der Rapid Sequence Induction (RSI) ist eine fundamentale Form der Anästhesieeinleitung bei nicht nüchternen Patienten zur Verhinderung der Aspiration von Mageninhalt. Schwangere und Kinder sind aufgrund ihrer Hypoxiegefährdung eine besondere Herausforderung; das klassische RSI-Konzept „Induktion – Apnoe – (Krikoiddruck –) Intubation“ muss bei ihnen zugunsten einer kontrollierten Technik mit Erhalt der Oxygenierung modifiziert werden.

Abstract

Aspiration during anesthesia induction is no triviality, but can lead to serious complications and mortality. The classic technique of rapid sequence induction (RSI) is a fundamental form of anesthesia induction in non-fasting patients to prevent pulmonary aspiration of gastric contents.

Pregnant women and children pose a special challenge due to their hypoxia risk; the classical RSI concept “induction – apnea – (cricoid pressure –) intubation” can lead to hypoxia and therefore must be modified in favor of a controlled technique with preservation of oxygenation in this patient group. A controlled procedure with continuous oxygenation as far as possible should be used.

The preparation of an RSI involves the careful selection of medicines, equipment and monitoring. An important quality criterion of RSI is the atraumatic airway management in deep anesthesia with profound muscle relaxation without resistance (coughing, choking, pressing) of the patient.

Kernaussagen

• Die Aspiration während der Anästhesieeinleitung ist keine Bagatelle. Sie kann zu schweren Komplikationen und Todesfällen führen.

• Die klassische RSI mit „Induktion – Apnoe – Krikoiddruck – Intubation“ führt bei Risikopatienten zu Hypoxie.

• Bei Kindern und Schwangeren soll ein modifiziertes, kontrolliertes Verfahren mit möglichst kontinuierlicher Oxygenierung eingesetzt werden.

• Die Vorbereitung einer RSI beinhaltet die sorgfältige Auswahl von Medikamenten, Equipment und Monitoring.

• Ein wichtiges Qualitätskriterium der RSI ist die atraumatische Atemwegssicherung in tiefer Anästhesie mit profunder Muskelrelaxierung ohne Gegenwehr (Husten, Würgen, Pressen) des Patienten.

Schlüsselwörter

Kinderanästhesie - Anästhesie in der Geburtshilfe - pulmonale Aspiration - Rapid Sequence Induction

Key words

pediatric anesthesia - obstetric anesthesia - pulmonary aspiration - rapid sequence induction

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