Das Kind mit einem Atemwegsinfekt – Wann und wie führe ich die Narkose?

Zusammenfassung

Infektionen der oberen Atemwege (URI) sind die häufigste präoperativ anzutreffende Komorbidität im Kindesalter. Ob eine Anästhesie für ein Kind mit Atemwegsinfekt durchgeführt oder besser verschoben werden soll, ist immer noch ein Dilemma für viele Anästhesisten. Die Gründe dafür sind nachvollziehbar: Atemwegsinfekte gehen mit einer erhöhten Rate an perioperativen respiratorischen Komplikationen einher, und es gibt bislang keine evidenz-basierten Empfehlungen für das Vorgehen im individuellen Fall. Ursächlich scheint die dem Asthma bronchiale ähnliche Hyperreaktivität der Atemwege zu sein. Typische respiratorische Komplikationen sind Laryngo- und Bronchospasmus, die zwar meist ohne bedrohliche Folge bleiben, aber –wenn sie nicht schnell erkannt und therapiert werden- das Potenzial schwerer Folgeschäden haben. Risikofaktoren für respiratorische Komplikationen sind u.a. Alter < 1 Jahr, pulmonale Komorbidität, invasiver Atemweg und atemwegsnahe Operation; für die Einzelfallentscheidung spielen neben den Risiko- v.a. auch die Nutzenfaktoren und die Kompetenz des Behandlungsteams eine entscheidende Rolle.

Abstract

Infections of the upper respiratory tract ( URI) are the most common preoperative encountered comorbidity in childhood. Whether anesthesia for a child with respiratory infection should be performed or better be canceled, is still a dilemma for many anesthetists. The reasons for this are understandable: respiratory infections are associated with an increased incidence of perioperative respiratory adverse events, and there have been no evidence-based recommendations for the procedure in the individual case. The reason appears to be the asthma-like airway hyperreactivity. Typical respiratory adverse events are laryngo- and bronchospasm. Although most of them remain without serious sequelae they have potential for serious morbidity and mortality when not immediately diagnosed and treated. Risk factors for respiratory complications include age <1 year , pulmonary comorbidity, invasive airway and airway surgery. Hence the individual decision is dependant on the risk but also the benefit factors and the expertise of the medical team.

Kernaussagen

• Kinder leiden in den 1. Lebensjahren im Durchschnitt 6–8 × pro Jahr an hauptsächlich viralen Atemwegsinfekten.

• Die virale Invasion des respiratorischen Epithels und der Schleimhaut kann zu bis zu 6 Wochen anhaltender bronchialer Hyperreagibilität und Bronchokonstriktion führen, ähnlich wie bei Asthma bronchiale.

• Kinder mit Atemwegsinfekten haben häufiger perioperative respiratorische Komplikationen (PRAE).

• Die sorgfältige präoperative Beurteilung ist der erste Schritt in einer individuellen Risiko-Nutzen-Abwägung, ob eine Anästhesie verschoben oder durchgeführt werden soll.

• Produktiver Husten, eitriges Sekret, Fieber und starkes Krankheitsgefühl sind übliche Kriterien für das Verschieben eines elektiven Eingriffs.

• Optimales Narkosemanagement beinhaltet eine inhalative Vorbehandlung mit Salbutamol, die Verwendung von Propofol sowie die Vermeidung entbehrlicher Atemwegsmanipulationen.

• Die Erfahrung des Anästhesisten und des gesamten Teams ist entscheidend für die Prävention, Antizipation und rasche Therapie perioperativer Komplikationen.

Schlüsselwörter:

Kinderanästhesie - Atemwegsinfekt - respiratorische Komplikationen - perioperative Komplikationen - Laryngospasmus

Key words:

pediatric anesthesia - upper respiratory tract infection - respiratory adverse events - perioperative complications - laryngospasm

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