Anästhesie bei nicht intubierter videoassistierter Thoraxchirurgie (NiVATS)

Die nicht intubierte videoassistierte thorakoskopische Chirurgie (NiVATS) gewinnt zunehmend an Bedeutung. Unter den richtigen Voraussetzungen ermöglicht sie auch Patienten mit relevantem Risiko für eine Allgemeinanästhesie eine sichere operative Versorgung intrathorakaler Pathologien. Der Beitrag stellt die potenziellen Vor- und Nachteile vor und beschreibt das Vorgehen in der Praxis.

Abstract

Non-intubated thoracic surgery is currently gaining popularity. In select patients and in experienced centres, non-intubated approaches may enable patients to safely undergo thoracic surgical procedures, who would otherwise be considered at high risk from general anaesthesia. While non-intubated techniques have been widely adopted for minor surgical procedures, its role in major thoracic surgery is a topic of controversial debate.

This article discusses disadvantages of intubated anaesthetic approaches and advantages of non-intubated thoracic surgery as well as the anaesthetic management. This includes surgical and anaesthetic criteria for patient selection, suitable regional anaesthetic techniques, concepts for sedation and maintenance of airway patency as well as the management of perioperative complications.

Non-intubated thoracic surgery has the potential to reduce postoperative morbidity and hospital length of stay. Successful non-intubated management depends on a standardised and well-trained interdisciplinary approach, especially regarding patient selection and perioperative complications.

Kernaussagen

• Die NiVATS ist für ein erfahrenes und geübtes interdisziplinäres Team ein sicheres Verfahren, das für den Patienten potenzielle Vorteile bietet.

• Wesentlich für den Erfolg sind eine gute interdisziplinäre Kommunikation und transparente Vorgehensweisen im Falle eines Versagens des nicht intubierten Verfahrens.

• Durch die NiVATS könnte die postoperative Morbidität gesenkt und die Krankenhausaufenthaltsdauer reduziert werden.

• Entsprechend dem allgemeinen Wandel der Analgesieverfahren in der Thoraxchirurgie werden auch bei der NiVATS verschiedenste neuere Verfahren erfolgreich erprobt.

• Für invasive Prozeduren, wie die Lobektomie, bietet jedoch die Katheter-Periduralanästhesie weiterhin v. a. durch die suffiziente viszerale Analgesie viele Vorteile.

Schlüsselwörter

Thoraxanästhesie - nichtintubierte VATS - Atemwegsmanagement - Spontanatmung - Regionalanästhesie

Keywords

thoracic anaesthesia - non-intubated - airway management - spontaneous breathing - regional anaesthesia

Publication History

Article published online:
21 June 2022

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