Geburtshilfliche Anästhesie – Erstversorgung und Reanimation von Neugeborenen

Kilian Kalmbach; Andreas Leonhardt

doi:10.1055/s-0031-1284472

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, Table of Contents

Anästhesiol Intensivmed Notfallmed Schmerzther 2011; 46(07/08): 496-506
DOI: 10.1055/s-0031-1284472

Fachwissen

A-Topthema: Geburtshilfliche Anästhesie

Geburtshilfliche Anästhesie – Erstversorgung und Reanimation von Neugeborenen

Resuscitation of Newborn Infants

Kilian Kalmbach

,

Andreas Leonhardt

Abstract

Zusammenfassung

Die erfolgreiche Versorgung und Reanimation von Neugeborenen basiert auf Vorbereitung, genauer Evaluation und prompter Unterstützung entsprechend den kürzlich aktualisierten Empfehlungen durch trainierte Personen. Der wesentliche Schritt der normalen postnatalen Adaptation ist die erfolgreiche Entfaltung der Lunge während der ersten Atemzüge, weil erst danach venöses Blut nahezu vollständig zur Lunge gelangt und ein Gasaustausch stattfindet. Liegt eine Störung der Adaptation vor, muss deshalb durch geeignete Maßnahmen zunächst die Ventilation gesichert werden. Primär wird mit Raumluft (bei Termingeborenen) bzw. niedrigen Sauerstoff-Fraktionen (bei Frühgeborenen) beatmet. Im weiteren Verlauf wird so viel Sauerstoff gegeben, daß physiologische Werte der Sauerstoffsättigung resultieren. Kardiale Kompression wird erst nach suffizienter Beatmung und in einem Verhältnis zur Ventilation von 3:1 durchgeführt. Wesentlicher Bestandteil der Erstversorgung von Neugeborenen ist die konsequente Anwendung wärmeerhaltender Maßnahmen, da Neugeborene allein durch Hypothermie vital bedroht sind. Eine therapeutische Hypothermie darf daher erst nach erfolgreicher Reanimation in Absprache mit dem weiterversorgenden Perinatalzentrum erwogen werden.

Abstract

Successful resuscitation of newborn infants depends on adequate preparation, exact evaluation and prompt initiation of support according to the recently updated recommendations by trained personnel. The key step in postnatal adaptation is the initiation of breathing with a subsequent increase in pulmonary blood flow and pulmonary gas exchange. Therefore, in compromised newborn infants, adequate ventilation is the most important step in cardiopulmonary resuscitation. Ventilation should be initiated with room air in term infants and with low concentrations of supplemental oxygen in preterm infants. Subsequently, oxygen supplementation should always be guided by pulse oximetry. Chest compressions are only effective if adequate ventilation has been ensured. The compression ventilation ratio remains 3:1. The prevention of heat loss and maintaining a normal body temperature by adequate measures is an essential part of the care for healthy as well as asphyxiated infants. Therapeutic hypothermia should only be initiated after successfull resuscitation and consultation with the regional neonatal intensive care unit.

Schlüsselwörter:

Neugeborenes - Frühgeborenes - Reanimation - Beatmung - Review

Keywords:

newborn infants - preterm infants - resuscitation - oxygen supplementation - review

Full Text

References

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