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Anästhesiol Intensivmed Notfallmed Schmerzther 2020; 55(11/12): 662-673
DOI: 10.1055/a-1070-6810
Topthema

Notsectio: eine Herausforderung in der geburtshilflichen Anästhesie

Jessica Wladarz
,
Manuel Wenk
,
Christina Massoth
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Die Notsectio ist einer der häufigsten geburtshilflichen Notfälle. Aufgrund des kritischen Zeitintervalls und einer von der Routine abweichenden Vorgehensweise ist sie eine besondere Herausforderung für die interprofessionelle Versorgung. Wesentlicher Anspruch aus anästhesiologischer Perspektive ist die schnellstmögliche Etablierung einer ausreichenden Anästhesietiefe bei gleichzeitiger Minimierung des Komplikationsrisikos.
Kernaussagen

  • Die Durchführung einer Schnittentbindung als Notsectio geht mit einer erhöhten maternalen und fetalen Morbidität einher.

  • Alarmierungsketten und Kommunikationswege müssen klinikintern in SOPs klar definiert und interdisziplinär bekannt sein, um kritische Zeitverzögerungen zu vermeiden.

  • Die Durchführung einer Allgemeinanästhesie ist nicht dogmatisch, sie ist jedoch bei geringerer geburtshilflicher Erfahrung des Anästhesisten das schnellste Verfahren mit der besten Erfolgsrate.

  • Die tatsächliche Häufigkeit schwieriger Atemwege ist in der Geburtshilfe wahrscheinlich deutlich geringer als bisher angenommen; Intubationsschwierigkeiten sind hier oft situativ bedingt.

  • Die Verfügbarkeit von Atemwegsalgorithmen, Larynxmasken der 2. Generation und Videolaryngoskopie haben das Risiko atemwegsassoziierter Komplikationen wesentlich reduziert.

  • Propofol spielt aufgrund der inzwischen besseren Anwendererfahrung bei vergleichbarem fetalen Outcome als Induktionshypnotikum eine zunehmend größere Rolle.

  • Hinsichtlich klinischer Outcome-Parameter stellen Succhinylcholin und Rocuronium gleichwertige Alternativen zur neuromuskulären Blockade dar.

  • Elektroenzephalografische Untersuchungen ergaben bei Schwangeren keine erhöhte Sensitivität auf volatile Anästhetika, sodass in Anbetracht des hohen Awareness-Risikos Unterdosierungen vermieden werden sollten.



Publication History

Article published online:
26 November 2020

© 2020. Thieme. All rights reserved.

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