Perioperatives Medikamentenmanagement

Zusammenfassung

Das perioperative Management der Dauermedikation von Patienten, die sich chirurgischen Eingriffen unterziehen müssen, erfordert ein rechtzeitiges und interdisziplinäres Zusammenspiel der einzelnen medizinischen Fachdisziplinen. Patienten mit einer höhergradigen ASA- Klassifikation (Evaluierung nach der Klassifikation der American Society of Anesthesiologists) sind häufig multimorbide Patienten, die an einer Vielzahl internistischer Erkrankungen leiden und eine große Anzahl an Medikamenten zur Therapie dieser Erkrankungen einnehmen. Mit einer steigenden Anzahl dieser Substanzen kommt es auch zu häufiger auftretenden Arzneimittelinteraktionen.

In der perioperativen Phase kommen noch Wechselwirkungen mit inhalativen und intravenösen Anästhetika sowie spezifische Blutungskomplikationen hinzu, die bereits präoperativ berücksichtigt werden müssen.

Die vorliegende Arbeit hat das Ziel, das perioperative Management der internistischen Begleittherapie bei nichtkardiochirurgischen Patienten an Hand der aktuellen Evidenz zusammenzufassen. Besonders auf dem Gebiet der kardiovaskulären Medikation sind in den letzten Jahren Evidenz basierte Empfehlungen publiziert worden, hier vor allem im Bereich der Beta-Blocker Therapie. Für andere Substanzgruppen bestehen die Empfehlungen weiterhin häufig aus Expertenmeinungen, pharmakologischen Empfehlungen, Arzneimittelinteraktionen oder Fallberichten, da nur wenige randomisiert kontrollierte Studien zur Verfügung stehen. Die vorliegenden epidemiologischen Studien sind heterogen.

Abstract

The management of chronic medication in the perioperative phase represents as a serious challenge for the involved physicians. Especially patients with elevated ASA-scores frequently suffer from multiple co-morbidities which often need numerous medications. The probability of pharmacological interactions rises with the number of these medications. Moreover it must be taken into consideration that chronic medication potentially interferes with both intravenous and inhaled anesthetics and moreover, bleeding complications are more likely to occur in patients undergoing chronic pharmacotherapy.

The aim of this article is to provide a summary of the existing evidence concerning perioperative medication in patients undergoing non-cardiac surgery. Several guidelines and advisories dealing with cardiovascular medication have been published during the last decade. The main scope of these publications was on beta-blockers and other cardiovascular medication. There is less evidence on not-cardiovascular medication as in most cases only case reports and expert opinions are published. Existing epidemiologic studies on this topic are rather heterogeneous.

Schlüsselwörter

perioperative Medikation - Chirurgie - Dauertherapie - Risikomanagement - Patientensicherheit

Keywords

perioperative medication - surgery - chronic medication - risk management - patient safety

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