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Anästhesiol Intensivmed Notfallmed Schmerzther 2021; 56(03): 201-209
DOI: 10.1055/a-1017-9138
Leitlinien in der Praxis

Leitlinien in der Praxis: Sedierung in der gastrointestinalen Endoskopie

The Guideline “Sedation for Gastrointestinal Endoscopy”
Peter H. Tonner
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Zusammenfassung

Ziel der Leitlinie „Sedierung in der gastrointestinalen Endoskopie“ ist die Definition struktureller, gerätetechnischer und personeller Anforderungen, die zur Risikominimierung der Sedierung bei Endoskopien beitragen. Dieser Artikel kommentiert wesentliche Aspekte der Leitlinie – insbesondere unter anästhesiologischen Gesichtspunkten. Eine Überarbeitung der Leitlinie steht bevor, dementsprechend wird auch auf neuere Entwicklungen eingegangen.

Abstract

The guideline “Sedation for gastrointestinal endoscopy” (AWMF-register-no. 021/014) was published initially in 2008. Because of new and developing evidence, the guideline was updated in 2015. The aim of the guideline is to define the necessary structural, equipment and personnel requirements that contribute to minimizing the risk of sedation for endoscopy. In view of the high and increasing significance of gastrointestinal endoscopy, the guideline will remain highly relevant in the future. Essential aspects are the selection of sedatives/hypnotics, structural requirements, personnel requirements with regard to number, availability and training, management of complications and quality assurance. In this article, the development and evaluation of the evidence and its influence on the practical implementation, in particular for anaesthesia, are highlighted.

Kernaussagen

  • Ein wesentlicher Gesichtspunkt der Leitlinie ist es, Komplikationen bei der Sedierung für endoskopische Eingriffe zu vermeiden.

  • Endoskopische Prozeduren und Interventionen werden immer langwieriger und komplexer. Auch werden mehr ältere, z. T. multimorbide Patienten behandelt, da endoskopische Eingriffe zunehmend größere operative Eingriffe ersetzen können. Daher wird die Sicherheit der Sedierung auch in Zukunft von hoher Relevanz sein.

  • Anhand einer Risikoeinstufung kann idealerweise vor einer geplanten Endoskopie festgelegt werden, ob ein Patient eine tiefe Sedierung und die Einbindung der Anästhesie benötigt.

  • Seit Beginn des Jahrtausends wird vor allem Propofol für die Sedierung in der Endoskopie verwendet. Bei den Benzodiazepinen hat sich Midazolam gegenüber Diazepam durchgesetzt.

  • Die Durchführung einer Sedierung durch nichtanästhesiologisches Personal wird bis heute diskutiert. Seit 2013 gibt es ein zertifiziertes Ausbildungscurriculum der DEGEA, das von den europäischen gastroenterologischen Gesellschaften übernommen wurde.

  • Zur Überwachung der Vitalfunktionen sedierter Patienten sind Pulsoxymetrie und Blutdruckmessung obligat, bei Patienten mit kardialen Risikofaktoren zusätzlich ein EKG.

  • Anästhesisten, die endoskopische Eingriffe betreuen, garantieren eine situativ angepasste, flexible Sedierung sowie die hämodynamische Kontrolle und Stabilität der Vitalzeichen.

  • Da der Bedarf an endoskopischer Diagnostik und Therapie – auch in tiefer Sedierung – weiter steigen wird, sollten alle Anästhesisten mit dieser Leitlinie vertraut sein.

Schlüsselwörter

gastrointestinale Endoskopie - Sedierung - Propofol - Monitoring - Komplikationen

Key words

gastrointestinal endoscopy - sedation - propofol - monitoring - complications


Publication History

Article published online:
16 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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