Der herzchirurgische Korrektureingriff

Zusammenfassung

Die Kenntnis von Pathophysiologie und dem spezifischen Einfluss auf das anästhesiologische Vorgehen ist für den betreuenden Anästhesisten bei Kindern mit angeborenen Herzfehlern von großer Bedeutung. Häufig bestimmen eingeschränkte Grenzen der hämodynamischen Stabilität das Vorgehen. Die große Herausforderung für den Anästhesisten besteht in der Aufrechterhaltung einer intraoperativen Homöostase bei verschiedensten operativen Eingriffen. Links-Rechts-Shunts führen zur linksventrikulären Volumenbelastung, welche häufig mit einem pulmonalen Hypertonus einhergeht. Rechts-Links-Shunts verursachen eine zentrale Zyanose.

Abstract:

Anesthesiologists involved in the care of children with congenital heart disease (CHD) have to understand the pathophysiology of each cardiac lesion and anticipate the impact of the planned procedure. Often the dimished margin of hemodynamic stability determines the guidelines of care. In children with CHD maintainance of the homeostasis during anesthesia for a wide variety of procedures is the anesthesiologist`s challenge. Left-to-right shunting means a volume load to the left ventricle frequently combined with pulmonary hypertension. Right-to-left shunting leads to a central cyanosis.

Schlüsselwörter:

Anästhesie - angeborene Herzfehler - FallotŽsche Tetralogie - Transposition der großen Arterien - HLHS

Keywords:

Anesthesia - Congenital heart disease - Tetralogy of Fallot - HLHS - Transposition of the great arteries

Kernaussagen

• Die Narkoseführung bei Kindern mit kongenitalen Vitien bedarf einer guten Kenntnis der Pathophysiologie und Hämodynamik des jeweiligen Herzfehlers.

• Bei Shuntvitien mit LR-Shunt kommt es zur Volumenbelastung des linken Ventrikels. Bei Shunts auf Ventrikelebene oder auf Ebene der großen Gefäße kann ein pulmonaler Hypertonus auftreten.

• RL-Shunts führen zu einer zentralen Zyanose. Besondere Sorgfalt ist wegen der akzidentiellen Luftembolie bei intravenösen Injektionen geboten.

• Bei turbulenten intrakardialen Flussmustern wie Shuntvitien, Klappenstenosen oder -insuffizienzen sowie bei komplexen Vitien ist ggf. eine Endokarditisprophylaxe durchzuführen.

• Patienten mit cavopulmonalen Anastomosen reagieren bei einer Erhöhung des PVR mit Absinken von Sättigung und HZV.

• Alle Maßnahmen, die eine Senkung des PVR induzieren, tragen zur Stabilisierung in einer solchen Situation bei.

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