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Anästhesiol Intensivmed Notfallmed Schmerzther 2013; 48(07/08): 494-501
DOI: 10.1055/s-0033-1352497
Fachwissen
Anästhesiologie & Intensivmedizin Topthema: Anästhesie in der Urologie
© Georg Thieme Verlag Stuttgart · New York

Anästhesie in der Urologie – Aktuelle Strategien zur Minimierung von Blutverlusten bei radikaler Prostatektomie

Current strategies to minimize of blood loss during radical prostatectomy
Christof M Strang
,
Thomas Hachenberg
Further Information

Publication History

Publication Date:
08 August 2013 (online)

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Zusammenfassung

Das Prostatakarzinom ist ein häufig diagnostiziertes Karzinom des männlichen Patienten mit einer hohen Inzidenz. Trotz Weiterentwicklung der chirurgischen Techniken zur Prostatektomie ist der perioperative Blutverlust mit konsekutiver Gabe von Erythrozyten weiterhin die häufigste Komplikation. Die kontrollierte Hypotension (MAD 60–70mmHg) aus einer Kombination aus thorakaler Epiduralanästhesie und restriktiver Flüssigkeitstherapie ist ein sicheres Verfahren, um den Blutverlust zu minimieren. Die 25°-Trendelenburglagerung unterstützt die multimodale Behandlung zur Hypotension. Tranexamsäure ist ein sicheres Medikament, um die Hyperfibrinolyse unter Prostataresektion zu behandeln.

Abstract

Prostate cancer is a frequently diagnosed cancer in men with a high incidence. Despite enhancements of surgical techniques in prostatectomyperioperative blood loss is still the most frequent complication. Controlled hypotension (MAP 60–70mmHg) consisting of thoracal epidural anaesthesia und restrictive fluid management is a safe method to minimize blood loss. 25 degrees Trendelenburg position supports the multimodal treatment of controlled hypotension. Tranexamic acid is a safe drug to treat hyperfibrinolysis during prostate resection.

Kernaussagen

  • Das Prostatakarzinom ist das zweithäufigste diagnostizierte Karzinom des männlichen Patienten.

  • Trotz Weiterentwicklung der operativen Methoden ist die perioperative Blutung eine der wichtigsten Komplikationen der radikalen retropubischen Prostatektomie.

  • Kontrollierte Hypotension ist ein sicheres Verfahren um den Blutverlust bei ASA-1-und ASA-2-Patienten unter Prostatektomie einzudämmen.

  • Richtwert des mittleren arteriellen Drucks der kontrollierten Hypotension sind beim gesunden Patienten 60–70mmHg.

  • Die Anlage eines thorakalen Epiduralkatheters ist empfehlenswert zur intraoperativen kontrollierten Hypotension und postoperativen Schmerztherapie.

  • Eine restriktive Flüssigkeitstherapie weist einen Vorteil bezüglich des Blutverlusts gegenüber der liberalen Flüssigkeitstherapie auf.

  • Infusionslösungen sollten möglichst nach der Präparationsphase der Prostata gegeben werden.

  • Die Trendelenburglagerung bis 25–30° scheint einen positiven Einfluss auf den perioperativen Blutverlust zu haben.

  • Vorsicht ist geboten bei der Rücklagerung von steilen Trendelenburglagerungen aufgrund der Umverteilung des Blutvolumens mit konsekutiver hämodynamischer Instabilität.

  • Die Prostata ist ein fibrinolytisch aktives Organ.

  • Tranexamsäure ist ein sicheres und preiswertes Medikament um die Hyperfibrinolyse zu behandeln.

  • Tranexamsäure kann auch bei ASA-Patienten der Klassen 3 und 4 angewendet werden, um dem Blutverlust zu minimieren.

Schlüsselwörter:

Prostataresektion - Blutverlust - kontrollierte Hypotension - Tranexamsäure

Key words:

prostate resection - blood loss - controlled hypotension - tranexamic acid

Ergänzendes Material

 

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