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Anästhesie zur Karotischirurgie

Gibt es einen Goldstandard?

Anesthesia for carotid artery surgery

Is there a gold standard?

  • Leitthema
  • Published:
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Zusammenfassung

Die Thrombendarteriektomie (TEA) der A. carotis ist trotz neuer Optionen die Therapie der Wahl in der kurativen Behandlung symptomatischer Karotisstenosen. Da die Patienten während der TEA v. a. durch zerebrale und auch myokardiale Ischämien gefährdet sind, muss das perioperative anästhesiologische Management vorrangig auf die Überwachung und die Sicherstellung der suffizienten Sauerstoffversorgung von Myokard und Gehirn abzielen. Seit Jahren wird kontrovers diskutiert, ob Allgemeinanästhesie- oder Regionalanästhesieverfahren das postoperative Ergebnis verbessern können. Die derzeit vorliegenden wenigen kontrollierten randomisierten Untersuchungen zeigen hinsichtlich harter Outcomeparameter keine signifikanten Vorteile eines der beiden Verfahren. Für die Wahl der Regionalanästhesie kann aufgrund des Evidenzlevels 1−–2+ allenfalls eine Grad-C-Empfehlung gegeben werden. Die vorliegende Arbeit gibt eine Übersicht über Besonderheiten und Zielsetzungen des anästhesiologischen Managements in der Karotischirurgie.

Abstract

Carotid endarterectomy (CEA) has remained the first choice of treatment in preventing ischemic stroke due to symptomatic stenosis of the internal carotid artery despite other new available options. During CEA patients are first and foremost at risk of cerebral as well as myocardial ischemia, therefore, maintenance of the oxygen supply to the brain and the myocardium is of outstanding importance requiring reliable monitoring of cerebral and cardiac function. The regional versus general anesthesia debate is an age-old one that has brought few definite answers regarding the impact on postoperative outcome of either anesthetic technique. Up to now, there is little evidence from only a few randomized clinical trials to demonstrate the superiority of either anesthetic technique with respect to outcome parameters. Because the level of evidence in favor of regional anesthesia during CEA can at least be rated between 1− and 2+ the resulting recommendation is grade C. The purpose of the review is to highlight the characteristics and goals of anesthetic management during CEA.

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Danksagung

Die Autoren danken PD Dr. med. H. Theilen und Dr. med. J. Schmidt für das zur Verfügung gestellte Bildmaterial und die inhaltliche Diskussion.

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  1. Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    T. Rössel, R.J. Litz, A.R. Heller & T. Koch

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  1. T. Rössel
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Thomas Rössel und Rainer J. Litz haben zu gleichen Teilen zur Abfassung des Manuskriptes beigetragen.

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Rössel, T., Litz, R., Heller, A. et al. Anästhesie zur Karotischirurgie. Anaesthesist 57, 115–130 (2008). https://doi.org/10.1007/s00101-008-1312-3

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