Perioperative Medizin in der Viszeralchirurgie beim alten Patienten aus anästhesiologischer Perspektive

Zusammenfassung

Der demografische Wandel führt zu einer zunehmenden Anzahl alter Patienten sowohl in unserer Gesellschaft als auch im Krankenhaus. Mit zunehmendem Alter steigt nicht nur die Anzahl der Vorerkrankungen, sondern auch die postoperative Komplikationsrate und Mortalität. Letztlich ist aber nicht das Alter ausschlaggebend, sondern der Zustand des Patienten und seine Kapazität, sich den körperlichen und mentalen Herausforderungen eines operativen Eingriffs zu stellen. Besonders von Komplikationen bedroht sind gebrechliche Patienten und eine wesentliche – als Prähabilitation – bezeichnete Strategie besteht darin, diese durch körperliches und mentales Training sowie Ernährungsberatung bereits präoperativ in einen besseren Zustand zu versetzen. Das Delir gehört zu den häufigsten postoperativen Komplikationen. Maßnahmen, wie der Verzicht auf eine Prämedikation mit Benzodiazepinen, die Messung der Narkosetiefe, der Verzicht auf langwirksame Opioide, die Durchführung von Fast-Track Surgery sowie die zügige postoperative Bereitstellung von Brille/Hörgerät können das Delirrisiko reduzieren. Eine enge interdisziplinäre Absprache zwischen Chirurgen, Anästhesisten, Geriatern und Physiotherapeuten ist wesentlich, um das perioperative Vorgehen miteinander abzustimmen und das perioperative Risiko für alte Patienten zu reduzieren.

Abstract

Demographic change is leading to an increasing number of old patients both in our society and in hospitals. With increasing age, not only the number of pre-existing conditions increases, but also the postoperative complication rate and mortality. Ultimately, however, it is not age that is decisive, but the condition of the patient and his or her capacity to face the physical and mental challenges of a surgical procedure. Frail patients are particularly at risk of complications, and an essential strategy – known as prehabilitation – is to put them in a better state pre-operatively through physical and mental training, as well as nutritional counselling. Delirium is one of the most frequent postoperative complications. Measures such as refraining from premedication with benzodiazepines, measuring the depth of anaesthesia, refraining from long-acting opioids, performing fast-track surgery, and providing glasses/hearing aids quickly postoperatively can reduce the risk of delirium. Close interdisciplinary consultation between surgeons, anaesthetists, geriatricians and physiotherapists is essential to coordinate the perioperative procedure and reduce the perioperative risk for elderly patients.

Schlüsselwörter

Viszeralchirurgie - postoperatives Delir - Gebrechlichkeit - Prähabilitation

Key words

abdominal surgery - postoperative delirium - frailty - prehabilitation

Publication History

Article published online:
21 June 2021

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