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Pathophysiologie Der Aufwachphase

Pathophysiologie Der Aufwachphase

          
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About the Book

In den letzten Jahren beobachten wir eine Zunahme großer chirurgischer Eingriffe bei Patienten mit hohem Narkose- und Operationsrisiko. Trotz dieser Entwicklung ist eher eine Abnahme der intraoperativen Komplikationshäufigkeit zu verzeichnen [21, 101]. Dabei hat die zunehmende Sicherheit des Patienten im Operationssaal in einigen Fäl- len das Problem der Narkose- und Operationsletalität in die postoperative Phase verschoben. Schon in der vielzitiert n Studie des Baltimore Anesthesia Study Committee [154] wurde diese Tendenz sichtbar, denn über 50% tödlicher teilweise anästhesiebedingter Komplikationen wurden postoperativ beobachtet. Auch neuere Untersuchungen von Harrison et al. [91] und Marx et al. [135] bestätigen dieses Ergebnis. Dabei ist das Auftreten postoperativer Komplikationen eng mit Vorerkrankungen des Patienten verbunden. Insbesondere erhöhen bronchopulmonale und kardiale Vor- erkrankungen sowie eine Operationsdauer über 120 min bei Abdominalchirurgie das postoperative Risiko [132]. Die kardiale Gefahrdung steigt deutlich, wenn präoperativ ein Herzinfarkt vorliegt und im perioperativen Verlauf niedrige Blutdrucke beobachtet werden [77, 187, 190]. Es ist jedoch noch ungeklärt, aus welchen Grunden und zu welchem Zeitpunkt ein perioperativer Herzinfarkt bei Fehlen einer identifizierbaren Periode niedriger Blut- drucke ausgelöst wird. Vormittag et al. [197] wiesen in diesem Zusammenhang bereits auf die Bedeutung der unmittelbaren postnarkotischen Reflexaktivierung als mögliche Herzinfarktursache hin, und auch in der neueren Untersuchung von Rao et al. [159] wird die Verminderung der Häufigkeit des postoperativen Myokardinfarkts auf eine blutdrucknormalisierende Therapie in der frühen postnarkotischen Periode bezogen.


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Product Details
  • ISBN-13: 9783540169079
  • Publisher: Springer
  • Publisher Imprint: Springer
  • Height: 244 mm
  • No of Pages: 108
  • Series Title: Anaesthesiologie Und Intensivmedizin Anaesthesiology and Int
  • Weight: 204 gr
  • ISBN-10: 3540169075
  • Publisher Date: 01 Nov 1986
  • Binding: Paperback
  • Language: German
  • Returnable: Y
  • Spine Width: 6 mm
  • Width: 170 mm


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