Akzidentelle Wachheit während Allgemeinanästhesie

Die akzidentelle Wachheit während der Allgemeinanästhesie ist eine seltene Komplikation, die jedoch zu schweren psychologischen Folgeerscheinungen führen kann. Dieser Fortbildungsbeitrag beleuchtet die Inzidenz der Komplikation, beschreibt das klinische Bild, die möglichen Ursachen, einige Diagnoseverfahren, das postoperative Management und Möglichkeiten der Prävention.

Abstract

Accidental awareness during general anaesthesia (AAGA) is a rare but severe complication. The reported incidence of AAGA may depend on the assessment of intraoperative awareness with explicit recall and there are substantial variations between subspecialties and groups of patients. The majority of prospective studies using structured interviews reported an incidence of AAGA at 0.1–0.2% during general anaesthesia, however, higher values were observed in paediatric (0.2–1.2%) and obstetric patients (0.47%). Risk factors that predispose to AAGA are patient conditions, ASA status, female gender, patient age, history of AAGA, surgical procedure, anaesthetic drug type, muscle relaxation, dosages of hypnotic or analgesic drugs, monitoring and malfunction of anaesthesia systems. Preventive strategies include careful assessment of risk factors, avoidance of underdosages of hypnotics and analgetics during general anaesthesia and monitoring of depth of anaesthesia in risk patients. The health-related consequences can be serious and psychopharmacological and psychotherapeutic interventions are indicated in patients who have experienced AAGA.

Kernaussagen

• Die Hauptziele der Allgemeinanästhesie sind Bewusstlosigkeit (Hypnose), Amnesie, Schmerzfreiheit, Unterdrückung autonomer Reaktionen und je nach Operation eine Muskelrelaxation.

• In seltenen Fällen erfolgt die Ausschaltung des Bewusstseins nur partiell oder zeitweise überhaupt nicht.

• Es wird bei einer akzidentellen Wachheit während Allgemeinanästhesie (AAGA) zwischen bewusst (explizit) und unbewusst (implizit) erinnerten Inhalten unterschieden.

• Nach großen, prospektiven Studien mit strukturiertem Interview beträgt die Inzidenz von AAGA mit expliziter Erinnerung bei Erwachsenen 0,1–0,2% der Allgemeinanästhesien.

• Bei pädiatrischen Patienten (0,2–1,2%) und Sectio caesarea (0,47%) ist die Inzidenz signifikant höher.

• Patienten mit AAGA berichten von gehörten Stimmen, Angst, Hilflosigkeit, Operationsdetails, Lähmung und Schmerz, was zu einem posttraumatischen Stresssyndrom führen kann.

• Die Ursache der AAGA liegt immer in einer faktischen Unterdosierung der Kombination aus Opioid und Hypnotikum.

• Patientenbezogene Risikofaktoren für AAGA umfassen Patientenmerkmale, ASA-Status > III, eingeschränkte hämodynamische Funktion, Patientenalter, weibliches Geschlecht, anamnestisch stattgehabte Awareness.

• Nicht patientenbezogene Risikofaktoren für AAGA sind die Anästhesietechnik, Verwendung von Muskelrelaxanzien, Art des operativen Eingriffs (Geburtshilfe, Herzchirurgie, Notfallchirurgie), Organisationsfaktoren.

• Die Prävention von AAGA umfasst die Überprüfung sämtlicher intraoperativ verwendeter technischer Geräte, sorgfältige präoperative Erfassung von Risikofaktoren und die Verwendung von Neuromonitoring bei Risikopatienten.

• Beim Eintritt von AAGA muss zeitnah ein Gespräch mit dem betroffenen Patienten geführt und falls notwendig eine psychotherapeutische Behandlung eingeleitet werden.

Schlüsselwörter

akzidentelle Wachheit - intraoperative Wachheit - Allgemeinanästhesie - Inzidenz - Risikofaktoren - Monitoring - Prävention - postoperative Behandlung

Keywords

accidental awareness - intraoperative awareness - incidence - risc factors - monitoring - postoperative treatment - AAGA

Publikationsverlauf

Artikel online veröffentlicht:
29. Juni 2023

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