Präoperative Risikoevaluation

Die präoperative Einschätzung und perioperative Betreuung von Patienten können, je nach individuellem Risiko, eine erhebliche Herausforderung darstellen. Mit der neuen Guideline der European Society of Anaesthesiology wollen die Autoren zur Entscheidungsfindung eines optimalen Managements vor elektiven Eingriffen beitragen.

Preoperative evaluation of patients – new ESA Guidelines

In June 2018, a revised version of the 2011 ESA Guidelines on Preoperative Evaluation of Patients undergoing Non-cardiac Surgery was published. Major changes were made by an international group of experts based on recent literature and data. Their main goal within these guidelines is to answer two basic questions: How should preoperative evaluation be organized? How should the patient be evaluated, including a profound risk assessment? Due to contradictory or insignificant data or studies of low quality one will mainly find recommendations with rather low grades of evidence. As mentioned by the authors themselves, the guidelines will provide a framework for the anesthetist to work with rather than offering a specific strategy. In the recent past, international guidelines on single aspects of preoperative evaluation have been published, especially in Europe there are guidelines on specific groups of patients, like patients with diabetes or the geriatric patient. The 2018 ESA Guidelines therefore often refer to those guidelines as cross-references. Specific topics, like for example pregnancy, are not part of the guidelines at hand. Also, a section about how to handle allergies has been taken out compared to the previous version.

Kernaussagen

• Im Juni 2018 wurde eine überarbeitete Version der Leitlinie der European Society of Anaesthesiology (ESA) zur präoperativen Evaluation nicht kardiochirurgischer Patienten veröffentlicht. Verfasst durch ein internationales Expertengremium wurden darin in einigen Bereichen umfassende Erweiterungen und Änderungen der vorherigen Leitlinie aus dem Jahr 2011 vorgenommen.

• Die Autoren der Leitlinie möchten vorrangig die beiden folgenden Fragen beantworten:

  • Wie sollte die Visite zur präoperativen Evaluation organisiert sein?

  • In welcher Weise sollte die präoperative (Risiko-)Einschätzung des Patienten erfolgen?

• Aufgrund der widersprüchlichen, wenig signifikanten oder teilweise qualitativ schlechten Studienlage zu den verschiedenen Aspekten der präoperativen Evaluation findet man nur wenige starke Empfehlungen mit hohen Evidenzgraden. Wie auch von den Autoren in der Präambel erwähnt, gibt die Leitlinie zumeist eher einen Rahmen vor, in dem sich der behandelnde Arzt bei der Entscheidungsfindung bewegen kann, als dass sie eine klare Handlungsstrategie beinhaltet.

• In jüngerer Vergangenheit sind international Leitlinien zu einzelnen Aspekten der präoperativen Evaluation erschienen. Insbesondere im europäischen Ausland werden hier besondere Patientengruppen, z. B. Diabetiker oder geriatrische Patienten behandelt. Oft finden sich daher Querverweise innerhalb der ESA-Leitlinie.

• Zu einigen speziellen Themen, z. B. dem Umgang mit schwangeren Patientinnen, werden keine Empfehlungen gegeben, und ein Abschnitt über den Umgang mit Allergien aus den vorherigen Leitlinien wurde entfernt.

Schlüsselwörter

präoperatives Risiko - Anästhesiologie - Chirurgie - Leitlinie

Keywords

preoperative risk - anesthesiology - surgery - guideline

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