Zusammenfassung
Die Krankheitsschwere herzchirurgischer Patienten und die Komplexität der Eingriffe haben in den letzten Jahren deutlich zugenommen. Dies stellt nicht nur erhöhte Anforderungen an die neurologische und hämodynamische Überwachung, sondern macht es auch erforderlich, die hämodynamische Therapie – unter Berücksichtigung aktueller pharmakologischer Entwicklungen – individuell dem höheren Risikoprofil der Patienten anzupassen.
Abstract
Patients undergoing cardiac surgery are growing older, present with more comorbidities, and are frequently scheduled for more complex and prolonged surgical procedures. Routine application of neurological as well as extended hemodynamic monitoring combined with goal-directed perioperative hemodynamic optimization, targeting optimization of systemic and cerebral oxygen balance, show promise to reduce postoperative complications and to improve mortality in this high risk population. Expert recommendations suggest to avoid synthetic colloids for fluid optimization. Additionally, pathophysiological reasoning and results from recent trials suggest to start inotropic and vasoactive therapy primarily with non-adrenergic drugs like levosimendan and vasopressin and to add classical catecholamines like dobutamine and noradrenalin only if necessary to accomplish hemodynamic goals.
Schlüsselwörter
Kardioanästhesie - hämodynamisches Monitoring - Bispektralindex - zerebrale Oxymetrie - Inotropika - Vasopressoren
Key words
cardiac anesthesia - hemodynamic monitoring - bispectral index - cerebral oximetry - inotropes - vasopressors
