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Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52(05): 356-366
DOI: 10.1055/s-0042-108926
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CME-Fortbildung
Georg Thieme Verlag KG Stuttgart · New York

Präoperative Vorbereitung: Optimierung pulmonaler Erkrankungen

Preoperative Optimization of Pulmonary Diseases – an Approach
Haitham Mutlak
,
Achim Grünewaldt
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Publication History

Publication Date:
22 May 2017 (online)

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Zusammenfassung

Lungenerkrankungen wie COPD oder Asthma sind bedeutende Risikofaktoren perioperativer pulmonaler Komplikationen. Die Optimierung dieser Erkrankungen ist deshalb wichtiger Bestandteil des präoperativen Managements. Das Wissen um die Pathophysiologie und medikamentöse Therapie ist dabei essenziell.

Abstract

Preoperative identification of patients with an increased risk for perioperative pulmonary complications is crucial for the anesthesiological management. These complications were underestimated in the past, but are associated with an increased morbidity and mortality when occuring. Patients with preexisting pulmonary diseases are at increased risk for perioperative pulmonary complications. In the recent past more emphasis was placed on preoperative optimization of the underlying pulmonary diseases like COPD or Asthma bronchiale. The knowledge of pathophysiology and pharmacological treatment options in this special subset of patients is essential. It has been shown that preventive programs in the preoperative setting were able to reduce pulmonary complications.

Kernaussagen

  • Eine präoperative Optimierung von Lungenerkrankungen kann die Rate an perioperativen pulmonalen Komplikationen senken.

  • Die präoperative Detektion von pulmonalen Risikopatienten ist essenziell für die Planung des perioperativen Vorgehens.

  • Eine apparative Zusatzdiagnostik von Patienten mit pulmonalen Erkrankungen ist bei akuter Verschlechterung einer schon bestehenden Symptomatik oder unklaren Befunden indiziert.

  • Die COPD ist die häufigste Erkrankung der Atmungsorgane und mit einem erhöhten Risiko für perioperative pulmonale Komplikationen assoziiert.

  • Die medikamentöse Therapie der COPD erfolgt anhand von Stufenschemata.

  • Bei Patienten mit Asthma bronchiale liegt eine bronchiale Hyperreagibilität vor, die anfallsartig auftreten kann. Die Obstruktion ist in der Regel reversibel.

  • Ein Großteil der Asthmaerkrankungen ist atopischer Genese.

  • Auch durch Medikamente, die im Rahmen einer Allgemeinanästhesie verwendet werden, kann ein Bronchospasmus ausgelöst werden.

Schlüsselwörter

COPD - Asthma bronchiale - präoperative Evaluation - Anästhesie

Key words

COPD - Asthma bronchiale - preoperative evaluation - Anaesthesia
 

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