Sedierung in der Endoskopie: Vorbereitung, Medikamentenapplikation und Überwachung

Einleitung

Der Stellenwert der Sedierung in der gastrointestinalen Endoskopie hat in den letzten Jahren zunehmend an Interesse gewonnen und ist derzeit Gegenstand vieler, teils auch kontroverser Diskussionen.

Neben der Besprechung der optimalen Patientenvorbereitung, die zusätzlich zu einer adäquaten Aufklärung über die Sedierung auch die Risikostratifizierung des einzelnen Patienten - in Hinblick auf das Auftreten etwaiger Komplikationen - beinhaltet, soll ein Überblick über die derzeit gebräuchlichsten Sedativa und Analgetika (insbesondere unter Berücksichtigung der kurz wirksamen Substanzen) gegeben werden. Inwieweit die in der Schweiz und Teilen der USA bereits praktizierte Delegation der Sedierung mit Propofol an nichtärztliches Assistenzpersonal („nurse administered propofol sedation”) unter aktuellen juristischen Aspekten auch in Deutschland möglich ist, wird ausführlich erörtert. Ein entsprechendes Patientenmonitoring ist in jedem Fall als obligat anzusehen, wobei es zu prüfen gilt, ob neuere Monitoringverfahren hier eine sinnvolle und im klinischen Alltag auch praktikable Ergänzung darstellen. Eine aktuell in Entwicklung begriffene S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie” wird hoffentlich noch in diesem Jahr mehr Klarheit hinsichtlich noch offener Fragen und Unsicherheiten bringen.

Literatur

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