Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: Journal für Klinische Endokrinologie und Stoffwechsel 4/2017

01.12.2017 | Originalien

Perioperatives Management von Menschen mit Diabetes bei elektiven Eingriffen

Teil 2

verfasst von: Prof. Dr. R. Landgraf, V. Klauss, M. Middeke, F. Tretter, J. Koscielny

Erschienen in: Journal für Klinische Endokrinologie und Stoffwechsel | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten
share
TEILEN

Zusammenfassung

Größere diagnostische und therapeutische Eingriffe sind für Menschen mit Diabetes besonders problematisch und gefährlich. Stoffwechselentgleisungen, kardiovaskuläre, renale, neurologische, psychiatrische und thrombembolische Komplikationen sind nicht selten. Wesentliche Gründe für deren überdurchschnittliche Rate bei Diabetespatienten im Krankenhaus sind deren häufige Multimorbidität, die notwendige Polypharmazie, eine kurze Liegedauer, unzureichendes Training von Ärzten und Pflegepersonal dieser komplex Kranken, Kostendruck und ungenügende Vorbereitung der Patienten vor elektiven Eingriffen. Die perioperative Betreuung von Erwachsenen mit deren Diabeteserkrankung wurde im Teil 1 dieses Beitrags in den einzelnen Phasen von präoperativ bis zur Entlassung diskutiert (Der Diabetologe 2017. DOI: 10.​1007/​s11428-017-0202-1), im Teil 2 werden detaillierte Empfehlungen zum Umgang mit Psychopharmaka, Kardiaka, Antihypertensiva und Antikoagulanzien prä- und perioperativ gegeben.

Literatur
  1. Halkos ME, Lattouf OM, Puskas JD et al (2008) Elevated preoperative haemoglobin A1c level is associated with reduced long-term survival after coronary artery bypass surgery. Ann Thorac Surg 86:1431–1437View ArticlePubMed
  2. Sampson MJ, Dozio N, Ferguson B et al (2007) Total and excess bed occupancy by age, speciality and insulin use for nearly one million diabetes patients discharged from all English acute hospitals. Diabetes Res Clin Pract 77:92–98View ArticlePubMed
  3. American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults (2015) Postoperative delirium in older adults:best practice statement from the American Geriatrics Society. J Am Coll Surg 220:136–148View Article
  4. Inouye SK, Westendorp RG, Saczynski JS (2014) Delirium in elderly people. Lancet 383(9920):911–922View ArticlePubMed
  5. Rundshagen I (2014) Postoperative cognitive dysfunction. Dtsch Arztebl Int 111(8):119–125PubMedPubMed Central
  6. Saczynski JS, Marcantonio ER, Quach L et al (2012) Cognitive trajectories after postoperative delirium. N Engl J Med 367:30–39View ArticlePubMedPubMed Central
  7. Stransky M, Schmidt C, Ganslmeier P et al (2011) Hypoactive delirium after cardiac surgery as an independent risk factor for prolonged mechanical ventilation. J Cardiothorac Vasc Anesth 25(6):968–974View ArticlePubMed
  8. Tretter F (Hrsg) (2000) Suchtmedizin. Schattauer, F.K. Verlag, Stuttgart
  9. ESC, ESA (2014) Guidelines on non-cardiac surgery: cardiovascular assessment and management. The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J 35(2):2383–2431
  10. Kelm M, Böhm M, Hoffmeister HM, Schächinger V (2014) Pocket-Leitlinie: Nicht-kardiale chirurgische Eingriffe. www.​dgk.​org. Zugegriffen: 20.03.2017
  11. Antoniou GA, Shahin Hajibandeh S, Hajibandeh S et al (2015) Meta-analysis of the effects of statins on perioperative outcomes in vascular and endovascular surgery. J Vasc Surg 61:519–532View ArticlePubMed
  12. Casadei B, Abuzeid H (2005) Is there a strong rationale for deferring elective surgery in patients with poorly controlled hypertension? J Hypertens 23:19–22View ArticlePubMed
  13. Knüttgen D, Büttner-Belz U, Gernot A, Doehn M (1990) Unstable blood pressure during anaethesia in diabetic patients with autonomic neuropathy. Anästh Intensivther Notfallmed 25(4):256–262View ArticlePubMed
  14. Chang DF, Campbell JR (2005) Intraoperative floppy iris syndrome associated with tamsulosine. J Cataract Refract Surg 31:664–673View ArticlePubMed
  15. Mancia G et al (2013) ESH/ESC guidelines for the management of arterial hypertension. J Hypertens 31:1281–1357View ArticlePubMed
  16. Manolis AJ, Erdine S, Borghi C, Tsioufis K (2010) Perioperative screening and management of hypertensive patients. Eur Soc Hypertens Sci Newsl 11:2
  17. Middeke M (2008) Arterielle Hypertonie – Arzneimittel-Dosierung am Anfang und Ende einer Therapie. Ther Umsch 65(10):577–584View ArticlePubMed
  18. London MJ, Hur K, Schwartz GG, Henderson WG (2013) Association of perioperative β‑blockade with mortality and cardiovascular morbidity following major noncardiac surgery. JAMA 309(16):1704–1713View ArticlePubMed
  19. Bouri S, Shun-Shin MS, Cole GD, Mayet J, Francis DP (2014) Meta-analysis of secure randomised controlled trials of β‑blockade to prevent perioperative death in non-cardiac surgery. Heart 100:456–464View ArticlePubMed
  20. Dunkelgrun M, Boersma E, Schouten O et al (2009) Bisoprolol and fluvastatin for the reduction of perioperative cardiac mortality and myocardial infarction in intermediate-risk patients undergoing noncardiovascular surgery: a randomized controlled trial (DECREASE-IV). Ann Surg 249(6):921–926View ArticlePubMed
  21. POISE study group (2008) Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 371(9627):1839–1847View Article
  22. Encke A, Haas S, Kopp I (2016) Clinical practice guideline: the prophylaxis of venous thromboembolism. Dtsch Arztebl Int 113:532–538PubMedPubMed Central
  23. Blaschke F, Lacour P, Wutzler A et al (2016) Managing periprocedural anticoagulation therapy in patients undergoing device implantation: survey in Germany, Austria and Switzerland. Acta Cardiol 71(5):549–556View ArticlePubMed
  24. von Heymann C, Koscielny J (2016) Patienten unter oraler Antikogulation mit VKA oder NOAK – Perioperatives „Bridging“ oder „Switching“? Anaesth Intensivmed 57:1–13
  25. Beyer-Westendorf J, Ebertz F, Forster K et al (2015) Effectiveness and safety of dabigatran therapy in daily-care patients with atrial fibrillation. Results from the Dresden NOAC Registry. Thromb Haemost 113:1247–1257View ArticlePubMed
  26. Douketis JD, Healey JS, Brueckmann M, Eikelboom JW, Ezekowitz MD, Fraessdorf M et al (2015) Perioperative bridging anticoagulation during dabigatran or warfarin interruption among patients who had an elective surgery or procedure. Substudy of the RE-LY trial. Thromb Haemost 113:625–632View ArticlePubMed
  27. Douketis JD, Spyropoulos AC, Spencer FA et al (2012) Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141:e326S–e350SView ArticlePubMedPubMed Central
  28. Hoffmeister HM, Bode C, Darius H et al (2010) Unterbrechung antithrombotischer Behandlung (Bridging) bei kardialen Erkrankungen. Positionspapier. Kardiologe 4:365–374View Article
  29. Mainz A (2013) „DEGAM S1-Handlungsempfehlung Bridging.“ Leitlinie „Bridging“ – AWMF. Registrierungsnummer: 053-027, Entwicklungsstufe: Federführende Fachgesellschaft(en): Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM)
  30. Spyropoulos AC, Douketis JD, Gerotziafas G et al (2012) Periprocedural antithrombotic and bridging therapy: recommendations for standardized reporting in patients with arterial indications for chronic oral anticoagulant therapy. J Thromb Haemost 10:692–694View ArticlePubMed
  31. Spyropoulos AC, Douketis JD (2012) How I treat anticoagulated patients undergoing an elective procedure or surgery. Blood 120:2954–2962View ArticlePubMed
  32. Egan G, Ensom MH (2015) Measuring anti-factor xa activity to monitor low-molecular weight heparin in obesity: a critical review. Can J Hosp Pharm 68:33–47PubMedPubMed Central
  33. Hammerstingl COH, Nickenig G (2009) Peri-operatives Bridging einer oralen Antikoagulation bei Patienten mit chronischer Niereninsuffizienz. Kardiologie 16:290–294
  34. Aren C, Feddersen K, Radegran K (1987) Comparison of two protocols for heparin neutralization by protamine after cardiopulmonary bypass. J Thorac Cardiovasc Surg 94:539–541PubMed
  35. Holst J, Lindblad B, Bergqvist D et al (1994) Protamine neutralization of intravenous and subcutaneous low-molecular-weight heparin (tinzaparin, Logiparin). An experimental investigation in healthy volunteers. Blood Coagul Fibrinolysis 5:795–803View ArticlePubMed
  36. van Ryn-McKenna J, Cai L, Ofosu FA et al (1990) Neutralization of enoxaparine-induced bleeding by protamine sulfate. Thromb Haemost 63:271–274PubMed
  37. Droppa M, Spannagl M, Geisler T (2016) Diabetespatienten mit kardiovaskulärer Erkrankung. Fokus Thrombozytenaggregationshemmung. Diabetologe 12:49–68View Article
  38. Roffi M, Patrono C, Collet JP et al (2016) 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 37:267–315View ArticlePubMed
  39. Steg PG, James SK, Atar D et al (2012) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 33:2569–2619View ArticlePubMed
  40. Fachinformation Efient®. Stand 01/2014
  41. Fachinformation Brilique® 90 mg/60 mg. Stand 02/2016
  42. Fachinformation Plavix®. Stand 09/2015
  43. Fleisher LA, Fleischmann KE, Auerbach AD et al (2014) 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 64:e77–e137View ArticlePubMed
  44. Tantry US, Bonello L, Aradi D et al (2013) Consensus and update on the definition of on-treatment platelet reactivity to adenosine diphosphate associated with ischemia and bleeding. J Am Coll Cardiol 62:2261–2273View ArticlePubMed
  45. Korte W, Cattaneo M, Chassot PG et al (2011) Peri-operative management of antiplatelet therapy in patients with coronary artery disease: joint position paper by members of the working group on Perioperative Haemostasis of the Society on Thrombosis and Haemostasis Research (GTH), the working group on Perioperative Coagulation of the Austrian Society for Anesthesiology, Resuscitation and Intensive Care (OGARI) and the Working Group Thrombosis of the European Society for Cardiology (ESC). J Thromb Haemost 105:743–749View Article
  46. Koscielny J, Rutkauskaite E (2013) Präinterventionelle Änderung der Gerinnungsmedikation. Viszeralmedizin. doi:10.​1159/​000355383
  47. Braun O, Erlinge D, Wallén H et al (2015) Clinical recommendations for surgery and bleeding during treatment with oral antiplatelet agents. Developed at the request of the Swedish Society of Cardiology and the Swedish Society on Thrombosis and Haemostasis 2015. www.​cardio.​se/​sites/​default/​files/​Clinical%20​recommendations%20​oral%20​antiplatelet%20​agents.​pdf. Zugegriffen: 09. März 2016
  48. Zeymer U, Koscielny J, von Heymann C et al (2016) Bleeding in patients receiving dual antiplatelet therapy after acute coronary syndrome – significance, prevention and interdisciplinary management. Dtsch Med Wochenschr 141:1107–1111View ArticlePubMed
Metadaten
Titel
Perioperatives Management von Menschen mit Diabetes bei elektiven Eingriffen
Teil 2
verfasst von
Prof. Dr. R. Landgraf
V. Klauss
M. Middeke
F. Tretter
J. Koscielny
Publikationsdatum
01.12.2017
Verlag
Springer Vienna
Erschienen in
Journal für Klinische Endokrinologie und Stoffwechsel / Ausgabe 4/2017
Print ISSN: 1998-7773
Elektronische ISSN: 1998-7781
DOI
https://doi.org/10.1007/s41969-017-0003-6