Awareness – Stellenwert des Neuromonitorings von Analgesie und Hypnose

Zusammenfassung

Unerwünschte intraoperative Wachheit (Awareness) ist eine seltene, mitunter aber schwerwiegende Folge zu oberflächlicher Allgemeinanästhesie. In der klinischen Routine erfolgt die Einschätzung der Narkosetiefe auf Basis klinischer und vegetativer Parameter. Zusätzliches apparatives Monitoring der Narkosetiefe stellt einen Ansatz zur Vermeidung von Awareness dar.

Zur Überwachung der Hypnosetiefe wurden auf Basis des EEG verschiedene Monitorsysteme entwickelt und vermarktet. Der Bispektrale Index (Covidien, Irland) ist das momentanmeistuntersuchte Monitorsystem zur Messung der Hypnosetiefe und konnte in Risikokollektiven die Inzidenz von Awareness reduzieren. Auch Protokolle auf Basis von Anästhetikakonzentration konnten in Risikogruppen die Inzidenz von Awareness bei Inhalationsanästhesien in ähnlicher Weise senken. Für andere EEG-basierte Monitorsysteme, aber auch Systeme, die speziell zum Einschätzen der Analgesie entwickelt wurden, liegen bislang weniger Daten bezüglich des Einflusses auf Awareness vor. Weitere Studien sind notwendig, um eine Aussage bezüglich deren Einfluss auf Awareness zu treffen.

Abstract

Awareness is a rare but in some cases severe complication of general anesthesia. In clinical practice vegetative signs such as sweating, lacrimation, tachycardia and hypertension are used to assess the anesthetic depth. Awareness however may also occur without any of these signs. Different systems based on the electroencephalogram (EEG) have been developed to monitor hypnosis. Some studies have shown that the use of EEG based monitor systems can reduce the incidence of awareness in patients of high risk. A similar reduction of the incidence was reached in studies using protocols based on concentrations of volatile anesthetics. Other systems to monitor anesthetic depth have been developed, but their influence on awareness has not yet been investigated sufficiently. Further studies are needed to clarify their impact concerning the incidence of awareness.

Kernaussagen

• Zur Beurteilung der Narkosetiefe stehen verschiedene apparative Möglichkeiten zur Überwachung von Hypnose, Analgesie und Anästhetikakonzentrationen zu Verfügung.

• Es konnte gezeigt werden, dass EEG-basierte Hypnosemonitore neben der Reduktion des Anästhetikaverbrauchs und der postoperativen Erholungzeit zumindest in Risikokollektiven auch zu einer Reduktion von Awareness beitragen können.

• Eine vergleichbare Reduktion des Awareness-Risikos konnte bei Inhalationsanästhesie durch eine Narkosesteuerung anhand von Konzentrationsparametern (minimale alveoläre Konzentration, MAC) gezeigt werden.

• Eine optimierte Analgesie könnte durch Vermeidung von Weckreaktionen („Arousal“) zur Vermeidung von Awareness beitragen. Aktuelle Ansätze für Analgesiemonitore sind klinisch derzeit nur wenig etabliert und wurden bisher nicht hinsichtlich ihrer Einflüsse auf Awareness untersucht.

Schlüsselwörter:

Allgemeinanästhesie - Narkosetiefe - Awareness - Neuromonitoring

Key words:

general anesthesia - awareness - Neuromonitoring - anesthetic depth

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