Kernaussagen
Vorbereitung
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Vor Beginn der Untersuchung ist für den Patienten eine individuelle Risikoabschätzung hinsichtlich möglicher kardiorespiratorischer Probleme zwingend erforderlich. Eine vollständige Notfallausrüstung muss unmittelbar verfügbar sein.
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Außer bei COPD-Patienten hat sich die Gabe von 2 l Sauerstoff per Nasensonde zur Vermeidung von Hypoxämien als günstig erwiesen.
Sedierung
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Bei rein diagnostischen, meist kurz dauernden Untersuchungen ist der Vorteil einer Sedierung hinsichtlich der Untersuchungseffizienz nicht eindeutig belegt.
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Midazolam hat sich aufgrund der im Vergleich zu Diazepam deutlich kürzeren Halbwertszeit unter den Benzodiazepinen durchgesetzt.
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Propofol hat sich anhand zahlreicher Studien mittlerweile gegenüber den Benzodiazepinen hinsichtlich der Sedierungseffizienz bei endoskopischen Interventionen als überlegen erwiesen, sodass es – auch aufgrund der vorteilhaften Pharmakokinetik und der deutlich kürzeren Aufwachzeit – inzwischen einen festen Platz im klinischen Alltag gefunden hat.
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Die Propofol-Sedierung kann an nicht ärztliches Assistenzpersonal delegiert werden unter der Voraussetzung, dass der delegierende Arzt in jedem Einzelfall über den Patienten informiert ist und ein zweiter für die Sedierung verantwortlicher Arzt in Rufweite zur Verfügung steht. Die Anwendung von Propofol in Einzelpraxen bleibt somit weiterhin problematisch.
Monitoring und Management nach der Sedierung
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Mindeststandard bei endoskopischen Untersuchungen ist der Einsatz der Pulsoxymetrie und des Blutdruck-Monitorings. Für aufwendigere Verfahren, wie Kapnografie und Neuromonitoring, konnte noch kein Sicherheitszugewinn für die Patienten nachgewiesen werden.
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Bei der Entlassung der Patienten aus dem ambulanten Bereich müssen die Minimalkriterien erfüllt sein. Die Patienten sollten nach Sedierung die Endoskopieeinheit in Begleitung verlassen.
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Die Wartezeit bis zur passiven und aktiven Teilnahme am Straßenverkehr sowie die Dauer der Arbeitsunfähigkeit richten sich nach der Halbwertszeit der für die Sedierung verwendeten Substanz.
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Dr. med. Andrea Riphaus
Medizinische Universitätsklinik
Ruhr-Universität Bochum
Knappschaftskrankenhaus
In der Schornau 23 – 25
44892 Bochum
eMail: ariphaus@web.de
Prof. Dr. Till Wehrmann
Leiter des FB Gastroenterologie
Stiftung Deutsche Klinik für Diagnostik GmbH
Aukammallee 33
65191 Wiesbaden
eMail: till.wehrmann@dkd-wiesbaden.de
