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Atemwegsmanagement bei der Ein-Lungen-Ventilation

Airway management for one-lung ventilation

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Zusammenfassung

Die zunehmend differenzierten und aufwendigen Operationsverfahren für intrathorakale chirurgische Eingriffe erfordern die sichere Seitentrennung der Atemwege und die Möglichkeit der Ein-Lungen-Ventilation. Da jeder Anästhesist im Rahmen der Versorgung von Traumapatienten oder bei akuten pulmonalen Notfällen mit der Notwendigkeit einer Seitentrennung der Atemwege konfrontiert werden kann, werden in dieser Übersichtsarbeit die derzeit gängigen Verfahren zur Lungentrennung und ihre Anwendung vorgestellt. Auf die besonderen Aspekte der Atemwegssicherung bei schwierigen Atemwegen und der Notwendigkeit der Seitentrennung der Atemwege wird eingegangen. Die resultierenden pathophysiologischen Effekte einer Ein-Lungen-Ventilation werden diskutiert und Strategien zur Aufrechterhaltung einer adäquaten Oxygenierung und Vermeidung einer Hypoxie aufgezeigt.

Abstract

The progress in sophisticated and complex operating methods for intrathoracic procedures demands reliable lung separation with the possibility of one-lung ventilation. Patients with thoracic traumas and pulmonary emergencies can confront any anaesthesiologist with the need for lung separating procedures. This review describes the contemporary procedures for lung separation. The special aspects of difficult airway management during one-lung ventilation and the indications for one-lung ventilation are described in detail. The pathophysiological changes during one-lung ventilation and strategies to avoid hypoxemia and to preserve adequate oxygenation are discussed.

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Motsch, J., Wiedemann, K. & Roggenbach, J. Atemwegsmanagement bei der Ein-Lungen-Ventilation. Anaesthesist 54, 601–624 (2005). https://doi.org/10.1007/s00101-005-0866-6

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