Erwachsene Patienten mit obstruktiver Schlafapnoe (OSA) – Perioperatives Management

Zusammenfassung

Die obstruktive Schlafapnoe (OSA) ist eine häufige schlaf-bezogene Atmungsstörung mit zunehmender Prävalenz. Die Erkrankung ist präoperativ in den meisten Fällen nicht bekannt, und die betroffenen Patienten haben ein erhöhtes Risiko für perioperative Komplikationen. Ein präoperatives Screening und ein perioperativer Behandlungsalgorithmus können die Patientensicherheit erhöhen.

Auch wenn das Evidenz-Niveau für einzelne Maßnahmen bislang noch unzureichend ist, erscheinen einige Punkte empfehlenswert. Sedierende Medikamente zur Prämedikation sollten nur äußerst zurückhaltend eingesetzt werden. Regionalanästhetische Verfahren sollten, wenn möglich, bevorzugt eingesetzt werden. Eine kontinuierliche postoperative Überwachung ist in ihrer Art und Dauer Patienten-individuell unterschiedlich und sollte mindestens so lange fortgeführt werden bis ein erhöhtes Risiko für postoperative Komplikationen nicht weiter besteht (Absetzen von Opioiden, frei wählbare Schlafposition, adäquate Oxygenierung, Wiederaufnahme der CPAP-Therapie).

Abstract

Obstructive sleep apnea (OSA) is a common sleep related breathing disorder with an increasing prevalence. Most surgical patients with OSA have not been diagnosed prior to surgery and are at an increased risk of developing perioperative complications. Preoperative identification of these patients is important in order to take appropriate measures concerning a safe perioperative management. While the level of scientific evidence for single measures is still low, several steps seem prudent: Preoperatively, sedating medications should only be applied with extreme caution. Anesthetic management should focus on regional anesthetic techniques and reduction of systemic opioids. In the case of general anesthesia, an increased risk of a patient presenting with a difficult airway should be appreciated. The extent and duration of postoperative continuous monitoring has to be determined on an individual basis. A preoperatively existing therapy with continuous positive airway pressure should be continued postoperatively as soon as possible. Patients with OSA may be managed on an outpatient basis if certain requirements are met.

Kernaussagen:

• Die Diagnose bzw. der Verdacht auf eine OSA sollte präoperativ möglichst frühzeitig bekannt sein, um ein adäquates perioperatives Management zu erlauben.

• Eine präoperativ bestehende CPAP-Therapie sollte perioperativ fortgeführt werden.

• Für die mit Bedacht einzusetzende medikamentöse Prämedikation bieten sich alpha-2-Agonisten an.

• Ein Schwerpunkt des intraoperativen Managements ist die Beherrschung des Atemwegs.

• Wann immer möglich sollte die systemische Gabe von Opioiden vermieden und der Einsatz lokal- und / oder regionalanästhesiologischer Methoden bevorzugt werden.

• Die Dauer einer kontinuierlichen postoperativen Überwachung eines OSA-Patienten muss im Einzelfall entschieden werden und ist von mehreren Faktoren abhängig. Dazu zählen der Schweregrad der bestehenden OSA-Erkrankung, die Invasivität des operativen Eingriffs sowie der zu erwartende postoperative Bedarf an Opioiden.

• Die kontinuierliche Überwachung sollte mind. so lange fortgeführt werden, bis ein erhöhtes Risiko für postoperative Komplikationen nicht weiter besteht (Absetzen von Opioiden, frei wählbare Schlafposition, adäquate Oxygenierung, Wiederaufnahme der CPAP-Therapie).

Schlüsselwörter:

Obstruktive Schlafapnoe - perioperative Komplikationen - perioperatives Management

Keywords:

Obstructive sleep apnea - perioperative complications - perioperative management

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