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Anästhesiol Intensivmed Notfallmed Schmerzther 2009; 44(11/12): 766-776
DOI: 10.1055/s-0029-1242129
Fachwissen
Topthema: Anästhesie bei neuromuskulären Erkrankungen
© Georg Thieme Verlag Stuttgart · New York

Regionalanästhesie als sinnvolle Alternative zur Allgemeinanästhesie? Überblick über die aktuelle Datenlage

Tim Papenfuß, Carmen Roch, Ulrich Schwemmer
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Publication History

Publication Date:
16 November 2009 (online)

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Zusammenfassung

Neuromuskuläre Erkrankungen sind seltene und häufig schlecht diagnostizierte Erkrankungen. Sie können in präjunktionale, junktionale oder postjunktionale Erkrankungen unterteilt werden. Da Allgemeinanästhesien mit einem deutlich erhöhten Risiko einhergehen, können regionalanästhesiologische Verfahren häufig als sicherere Alternative erwogen werden. Bei fehlenden Studien und Leitlinien zu fast allen Erkrankungen stellt die Entscheidung für die Regionalanästhesie eine individuelle Risiko–Nutzen–Abwägung dar. Diese muss ebenso wie der präoperative neurologische Status aus forensischen Gründen immer exakt dokumentiert werden.

Abstract

Neuromuscular disorders are rare and often not very well diagnosed diseases. They can be separated in prejunctional, junctional or postjunctional diseases. General anesthesia is connected with a higher risk, therefore regional anesthesia could often be regarded with favour and could be a save alternative. Because of the lack of systematically studies and guidelines the decision chosing a regional anesthesia is always a risk–benefit–analysis. This and also the detailed preoperative neurological status must, because of forensic reason, exactly be documented.

Schlüsselwörter

neuromuskuläre Erkrankungen - Regionalanästhesie - Epiduralanästhesie - Spinalanästhesie

Keywords

neuromuscular disorders - regional anaesthesia - epidural anesthesia - spinal anesthesia

Kernaussagen

  • Neuromuskuläre Erkrankungen (NME) werden nach der Lokalisation der betroffenen Strukturen in junktionale, prä– oder postjunktionale Störungen eingeteilt. Dabei kommt es zu Funktionsstörungen bei der Transmission, am Nerven oder Muskel.

  • Neuromuskuläre Erkrankungen gehen mit einem deutlich erhöhten perioperativen Risiko einher.

  • Die Kenntnis des aktuellen neurologischen Status, der Begleitsymptome sowie des individuellen Krankheitsverlaufs ist unverzichtbar.

  • Aufgrund der fehlenden Datenlage existieren für das anästhesiologische Vorgehen bei Patienten mit NME keine Empfehlungen.

  • Regionalanästhesiologische Verfahren können Risiken und Nebenwirkungen von Allgemeinanästhesien durch andere Wirkmechanismen umgehen.

  • Bei junktionalen und postjunktionalen Erkrankungen gelten Regionalanästhesieverfahren als sichere Alternative zur Allgemeinanästhesie.

  • Bei präjunktionalen Erkrankungen werden Regionalanästhesien kontrovers diskutiert. Nach einer individuellen Risiko–Nutzen–Abwägung könnten sie in ausgewählten Fällen eine Alternative zur Allgemeinanästhesie darstellen.

  • Ein ausführlicher Befund des prä– und postoperativen neurologischen Status sowie die Begründung der Entscheidungsfindung erscheinen aus medikolegaler Sicht bedeutsam.

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Dr. med. Tim Papenfuß
Dr. med. Carmen Roch
PD Dr. med. Ulrich Schwemmer

Email: papenfuss_t@klinik.uni-wuerzburg.de

Email: roch_c@klinik.uni-wuerzburg.de

Email: ulrich.schwemmer@klinikum.neumarkt.de

    Literaturverzeichnis