Outcome-relevante Anästhesiologie: intraoperatives hämodynamisches Monitoring und Management

Zusammenfassung

Hämodynamisches Monitoring und Management ist ein wichtiger Bestandteil einer jeden Narkose und damit von großer Bedeutung für die tägliche anästhesiologische Praxis. In diesem Beitrag werden die Grundlagen des hämodynamischen Monitorings dargelegt und die Relevanz eines intraoperativen hämodynamischen Managements aufgezeigt.

Abstract

Postoperative deaths are a consequence of postoperative complications – including acute kidney injury and myocardial injury. Postoperative complications are associated with non-modifiable patient-specific risk factors (i.e., age, medical history), but also with potentially modifiable risk factors – including intraoperative hypotension and compromised intraoperative blood flow. Based on patient- and surgery-specific risk factors, the intraoperative hemodynamic monitoring strategy needs to be selected. Intraoperative hypotension is associated with postoperative organ failure and should thus be avoided. To optimize intraoperative hemodynamics, cardiac output-guided hemodynamic management has been proposed. Cardiac output-guided hemodynamic management aims at optimizing oxygen delivery using fluids, vasopressors, and inotropes. Cardiac output-guided hemodynamic management has been shown to reduce postoperative complications compared to routine hemodynamic management in high-risk patients having major surgery.

Kernaussagen

• Die Auswahl des intraoperativen hämodynamischen Monitorings sollte an das individuelle operations- und patientenspezifische Risiko angepasst werden.

• Die invasive Blutdruckmessung mittels eines arteriellen Katheters ist das Referenzverfahren der arteriellen Blutdruckmessung.

• Intraoperative Hypotonie ist mit postoperativen Komplikationen assoziiert.

• Ein zielgerichtetes Herzzeitvolumen-gesteuertes Management soll einen adäquaten Blutfluss sowie ein ausreichendes Sauerstoffangebot gewährleisten.

• Therapiealgorithmen können bei der klinischen Umsetzung eines intraoperativen Herzzeitvolumen-gesteuerten Managements hilfreich sein.

Schlüsselwörter

Blutdruck - Blutfluss - Herzzeitvolumen - intraoperative zielgerichtete Therapie

Key words

blood pressure - blood flow - cardiac output - intraoperative goal-directed therapy

Publikationsverlauf

Artikel online veröffentlicht:
16. Februar 2022

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