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Neuromonitoring in der Kardioanästhesie

Gemeinsame Stellungnahme der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Schweizerischen Gesellschaft für Anästhesiologie und Reanimation (SGAR) und Deutschen Gesellschaft für Thorax-, Herz- und Gefäßchirurgie (DGTHG)

Neuromonitoring in cardiac anesthesia

Joint statement of the German Society of Anesthesiology and Intensive Care Medicine (DGAI), the Swiss Society for Anesthesiology and Resuscitation (SGAR) and the German Society for Thoracic and Cardiovascular Surgery (DGTHG)

  • Evidenzbasierte Medizin
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

An Erratum to this article was published on 12 August 2015

Zusammenfassung

Herzchirurgische Eingriffe sind nicht selten mit neurologischen Komplikationen verbunden. Die Ziele des Neuromonitorings in der Kardioanästhesie liegen in der Vermeidung derartiger Komplikationen, zum Beispiel durch die Detektion zerebraler Ischämien, die Erkennung einer inadäquaten Narkosetiefe oder die Überwachung von neuroprotektiven Maßnahmen. DGAI, DGTHG und SGAR empfehlen für die Herzchirurgie den Einsatz eines prozessierten EEGs bei totalintravenöser Anästhesie, bei tiefem hypothermem Kreislaufstillstand sowie bei Risikopatienten für Awareness. Bei Karotis-Thrombendartektomien wird die Ableitung von somatosensiblen Potenzialen (SSEP) als Verfahren der ersten Wahl angeraten. Falls ein SSEP-Gerät nicht zur Verfügung steht, wird die Anwendung der Nahinfrarotspektroskopie (NIRS) als Verfahren der zweiten Wahl empfohlen, wobei keine allgemein akzeptierten Grenzwerte für eine Shunt-Einlage vorliegen. Motorisch evozierte Potenziale sollten bei Operationen an der thorakalen Aorta descendens abgeleitet werden. Die beteiligten Gesellschaften sprechen sich für den Einsatz von NIRS zur Erkennung einer fehlerhaften Kanülenlage bei der Korrektur angeborener Herzfehler im Kindesalter sowie bei Operationen am Aortenbogen bei Kindern und Erwachsenen aus. Im Sinne einer Expertenmeinung wird die Anwendung von NIRS empfohlen bei Patienten mit stattgehabtem Apoplex, schwerer arterieller Hypertonie, hochgradigen Karotisstenosen sowie bei Herz- oder Lungentransplantationen.

Abstract

It is not uncommon for cardiac surgery to be associated with neurological complications. The aim of monitoring in cardiac anesthesia is the avoidance of such complications, e.g. by the detection of cerebral ischemia, recognition of an inadequate depth of anesthesia and surveillance of neuroprotective measures. For cardiac surgery the German Society of Anesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, DGAI), the German Society for Thoracic and Cardiovascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, DGTHG) and the Swiss Society for Anesthesiology and Resuscitation (Schweizerische Gesellschaft für Anästhesiologie und Reanimation, SGAR) recommend the use of processed electroencephalographs (EEG) for total intravenous anesthesia, for deep hypothermic cardiac arrest and in patients at risk for awareness. In carotid thromboendartectomy the afferent conduction of somatosensory evoked potentials (SSEP) is recommended as the method of choice. If an SSEP device is unavailable near-infrared spectroscopy (NIRS) is recommended as the second choice procedure, whereby no generally acceptable cut-off values for a shunt placement are available. Motor evoked potentials should be utilized in operations on the thoracic descending aorta. The participating societies are in favor of using NIRS for detection of an incorrectly placed cannula during correction of congenital heart defects in childhood and in operations on the aortic arch in children and adults. In the sense of an expert opinion, the use of NIRS is recommended for patients who have suffered an apoplexy, severe arterial hypertension, high-grade carotid artery stenosis as well as for heart or lung transplantation.

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Interessenkonflikt.

Für den Wissenschaftlichen Arbeitskreis Kardioanästhesie der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI):

  • I. Brandes: kein Interessenkonflikt,

  • M. Heringlake hat Forschungsunterstützung und Vortragshonorare von der Fa. Covidien erhalten,

  • A. Koster: kein Interessenkonflikt,

  • P. Michels: kein Interessenkonflikt,

  • U. Schirmer: kein Interessenkonflikt.

Für den Wissenschaftlichen Arbeitskreis Neuroanästhesie der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI):

  • M. Dinkel hat Vortragshonorare von den Firmen Inomed und Medtronic erhalten,

  • M. Menzel: kein Interessenkonflikt,

  • P. Michels: s. oben (kein Interessenkonflikt),

  • L. Schaffranietz: kein Interessenkonflikt,

  • G. Schneider: kein Interessenkonflikt,

  • M. Söhle hat Forschungsunterstützung und Vortragshonorare von der Fa. Covidien erhalten.

Für die Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie (DGTHG):

  • I. Eichler: kein Interessenkonflikt,

  • A. Markewitz: kein Interessenkonflikt.

Für die Cardiovascular and Thoracic Anaesthesia Group (CTA) der Schweizerischen Gesellschaft für Anästhesiologie und Reanimation (SGAR):

  • R. Basciani hat Vortragshonorare von den Firmen Covidien und Medtronic erhalten.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Schweizerische Gesellschaft für Anästhesiologie und Reanimation (SGAR), Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie (DGTHG)

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Dieser Beitrag ist erstpubliziert in „Anaesth Intensivmed 2014;55:521–538, mit freundlicher Genehmigung der Aktiv Druck &Verlag GmbH“.

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Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Schweizerische Gesellschaft für Anästhesiologie und Reanimation (SGAR), Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie (DGTHG). Neuromonitoring in der Kardioanästhesie. Z Herz- Thorax- Gefäßchir 28, 430–447 (2014). https://doi.org/10.1007/s00398-014-1125-4

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  • DOI: https://doi.org/10.1007/s00398-014-1125-4

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