Anästhesie in der extrathorakalen Gefäßchirurgie – Teil 1: Präoperative Therapieoptimierung

Zusammenfassung

Gefäßchirurgische Patienten haben aufgrund von häufig vorliegenden Komorbiditäten ein deutlich erhöhtes perioperatives Risiko. Eine präoperative Therapieoptimierung mit dem Versuch, vermeidbare Komplikationen zu reduzieren, ist oberstes Ziel einer sorgfältigen interdisziplinären Risikoevaluation. Die typischen kardiovaskulären Risikofaktoren wie ein arterieller Hypertonus, ein Diabetes mellitus, eine Herzinsuffizienz etc. müssen identifiziert und präoperativ medikamentös eingestellt werden.

Abstract

Vascular surgical patients have an increased perioperative risk for cardiovascular complications because of high incidence of cardiovascular risk factors. An optimization of the preoperative therapy is able to reduce the preventable cardiac complications. Cardiovascular risk factors such as high blood pressure, diabetes mellitus, heart failure have to be identified and treated.

Kernaussagen

• Die perioperative Behandlung gefäßchirurgischer Patienten kann anästhesiologisch eine Herausforderung sein. Aufgrund häufig bestehender Komorbiditäten sind die meisten Patienten als Risikopatienten einzustufen.

• Die präoperative Evaluation sollte interdisziplinär zur Abschätzung des perioperativen Risiko in ausreichendem zeitlichen Abstand zum operativen Eingriff erfolgen.

• Die perioperativ fortgesetzte Dauermedikation von Betarezeptorenblockern, Statinen und Thrombozytenaggregationshemmern stellt einen wesentlichen Faktor zur Reduktion des perioperativen Risikos dar.

• Ob neueste Studienergebnisse zur perioperativen Betarezeptorenblockade zu Änderungen der aktuellen Empfehlungen führen, bleibt abzuwarten.

Schlüsselwörter:

gefäßchirurgische Eingriffe - präoperative Risikoevaluation - kardiovaskuläre Risikofaktoren - perioperativeBetarezeptorenblockade - Statine

Key words:

vascular surgery procedures - preoperative risk evaluation - cardiovascular riskfactors - perioperative beta-adrenergic blockade - statins

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