Alkohol als perioperatives Problem in Anästhesiologie und Intensivmedizin

D. A. Vagts; T. Iber; G. F. E. Nöldge-Schomburg

doi:10.1055/s-2003-45400

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, Table of Contents

Anästhesiol Intensivmed Notfallmed Schmerzther 2003; 38(12): 747-761
DOI: 10.1055/s-2003-45400

Übersicht

Alkohol als perioperatives Problem in Anästhesiologie und Intensivmedizin

Alcohol - A Perioperative Problem of Anaesthesia and Intensive Care MedicineD. A. Vagts¹ , T. Iber¹ , G. F. E. Nöldge-Schomburg¹

¹Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universität Rostock

Abstract

Zusammenfassung

Alkohol ist eine gesellschaftlich akzeptierte Droge, deren Verwendung mit einer Reihe von aus anästhesiologischer Sicht unerwünschten Wirkungen einhergeht. Pharmakologische Interaktionen, akute pathophysiologische Veränderungen sowie chronische pathophysiologische Veränderungen erhöhen das Narkoserisiko eines Patienten. Im Gegensatz zum Opiatentzug kann der Alkoholentzug vital bedrohlich sein und muss deshalb verhindert oder zumindest unter kontrollierten Bedingungen abgeschwächt werden. Hierfür ist es notwendig, Alkoholiker anhand von Anamnese und Untersuchungen zu erkennen und eine Delirprophylaxe präoperativ zu beginnen. Dafür stehen für anästhesiologische Zwecke in erster Linie Benzodiazepine alleine oder in Kombination mit Clonidin zur Verfügung. Haloperidol ist Mittel der Wahl beim beginnenden Entzugsdelir mit produktiven Psychosen. Für das Abschätzen der Veränderungen intraoperativer pharmakologischer Dosierungen ist es notwendig zu wissen, ob es sich um einen Patienten mit gelegentlicher akuter Alkoholintoxikation, um eine chronische Alkoholintoxikation ohne Leberdekompensation oder um einen chronischen Alkoholabusus mit dekompensierter Leberfunktion handelt. Aufgrund der sowohl nach akutem als auch bei chronischem Alkoholkonsum entstehenden pathophysiologischen Veränderungen im Gastrointestinaltrakt sind alkoholkranke Patienten als nicht-nüchtern zu betrachten. Damit ist bei diesen Patienten eine Rapid Sequence Induction („Ileuseinleitung”) wegen erhöhter Aspirationsgefahr großzügig in Erwägung zu ziehen. Die Narkoseführung muss insbesondere auf den Erhalt der Leberperfusion und -oxygenierung abzielen, eine gute Steuerbarkeit zulassen und bei der Dosierung von Medikamenten den Zustand der Leberfunktion beachten. Postoperativ ist eine verlängerte Überwachung des akut alkoholisierten Patienten notwendig, der chronische Alkoholiker besitzt eine Indikation für eine engmaschige Kontrolle der Neurologie und Vitalparameter. Die postoperative Aufnahme auf die Intensivstation sollte in Abhängigkeit vom anästhesiologischen Gesamtrisiko großzügig erwogen werden. Für Regionalanästhesien gelten hinsichtlich Gerinnungsparametern und Kooperativität des Patienten die gleichen Kriterien wie für Nicht-Alkoholiker.

Abstract

Alcohol is a socially tolerated drug. Its consumption is associated with several physiological and pharmacological negative side-effects during anaesthesia and intensive care. The impact of chronic and acute alcoholism on perioperative morbidity and mortality and especially on anaesthetic risk are important, due to pharmacological interactions, pathophysiological changes and direct pharmacological interactivities between alcohol and narcotics. In contrast to opioid withdrawal symptoms of alcohol withdrawal are a serious and potentially life-threatening complication and should be avoided or the risk for occurrence must at least be reduced. Patients with a high risk of developing perioperative symptoms of alcohol withdrawal can be detected by laboratory tests and questionnaires. A prophylaxis of withdrawal should be started preoperatively solely with benzodiazepines or in combination with clonidine. Haloperidol is the drug of choice for emerging symptoms of alcohol withdrawal with productive psychosis. To estimate the pharmacological changes during anaesthesia, it is necessary to differentiate whether the patient is an occasional drinker with acute intoxication, a chronic abuser without limitations of hepatic function or a chronic user with insufficiency of the liver. The most important implication for anaesthesia are the choice of a rapid sequence induction to reduce the risk of aspiration and the maintenance of haemodynamic stability and liver perfusion. For the acute alcoholic providing prolonged postoperative surveillance is necessary, for the chronic alcoholic intensive care seems to be mandatory. For regional anaesthesia the indications and limitations are the same as for other patients (cooperativeness, coagulation, consent, etc.).

Schlüsselwörter

Narkose - Alkohol - Wirkungen - Aspiration - Arzneimittelinteraktionen - Delirprophylaxe

Key words

Anaesthesia - Alcohol - Aspiration - pharmacological interactions - delir - alcohol with drawal - prophylaxis

Full Text

References

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Dr. med. D. A. Vagts, DEAA, EDIC

Universität Rostock, Klinik und Poliklinik für Anästhesiologie und Intensivtherapie

Schillingallee 35

18055 Rostock

Email: dierk.vagts@medizin.uni-rostock.de