Präoperative Vorbereitung: Optimierung pulmonaler Erkrankungen

Zusammenfassung

Lungenerkrankungen wie COPD oder Asthma sind bedeutende Risikofaktoren perioperativer pulmonaler Komplikationen. Die Optimierung dieser Erkrankungen ist deshalb wichtiger Bestandteil des präoperativen Managements. Das Wissen um die Pathophysiologie und medikamentöse Therapie ist dabei essenziell.

Abstract

Preoperative identification of patients with an increased risk for perioperative pulmonary complications is crucial for the anesthesiological management. These complications were underestimated in the past, but are associated with an increased morbidity and mortality when occuring. Patients with preexisting pulmonary diseases are at increased risk for perioperative pulmonary complications. In the recent past more emphasis was placed on preoperative optimization of the underlying pulmonary diseases like COPD or Asthma bronchiale. The knowledge of pathophysiology and pharmacological treatment options in this special subset of patients is essential. It has been shown that preventive programs in the preoperative setting were able to reduce pulmonary complications.

Kernaussagen

• Eine präoperative Optimierung von Lungenerkrankungen kann die Rate an perioperativen pulmonalen Komplikationen senken.

• Die präoperative Detektion von pulmonalen Risikopatienten ist essenziell für die Planung des perioperativen Vorgehens.

• Eine apparative Zusatzdiagnostik von Patienten mit pulmonalen Erkrankungen ist bei akuter Verschlechterung einer schon bestehenden Symptomatik oder unklaren Befunden indiziert.

• Die COPD ist die häufigste Erkrankung der Atmungsorgane und mit einem erhöhten Risiko für perioperative pulmonale Komplikationen assoziiert.

• Die medikamentöse Therapie der COPD erfolgt anhand von Stufenschemata.

• Bei Patienten mit Asthma bronchiale liegt eine bronchiale Hyperreagibilität vor, die anfallsartig auftreten kann. Die Obstruktion ist in der Regel reversibel.

• Ein Großteil der Asthmaerkrankungen ist atopischer Genese.

• Auch durch Medikamente, die im Rahmen einer Allgemeinanästhesie verwendet werden, kann ein Bronchospasmus ausgelöst werden.

Schlüsselwörter

COPD - Asthma bronchiale - präoperative Evaluation - Anästhesie

Key words

COPD - Asthma bronchiale - preoperative evaluation - Anaesthesia

• Literatur

• 1 Aumann I, Prenzler A, Welte T. et al. [Epidemiology and costs of asthma in Germany - a systematic literature review]. Pneumologie 2014; 68: 557-567
• 2 Behr J. The diagnosis and treatment of idiopathic pulmonary fibrosis. Dtsch Arztebl Int 2013; 110: 875-881
• 3 Bettencourt PE, Del Bono EA, Spiegelman D. et al. Clinical utility of chest auscultation in common pulmonary diseases. Am J Respir Crit Care Med 1994; 150: 1291-1297
• 4 Blakey JD, Price DB, Pizzichini E. et al. Identifying Risk of Future Asthma Attacks Using UK Medical Record Data: A Respiratory Effectiveness Group Initiative. J Allergy Clin Immunol Pract 2016;
• 5 Böhmer AB, Wappler F, Zwißler B. Präoperative Risikoevaluation – von der Routinediagnostik zur patientenorientierten Strategie. Dtsch Arztebl Int 2014; 111: 437-446
• 6 Boulet LP. Asthma in the elderly patient. Asthma Res Pract 2016;
• 7 Bremerich DH, Hachenberg T. [Anesthesia and restrictive and obstructive pulmonary diseases]. Anasthesiol Intensivmed Notfallmed Schmerzther 2007; 42: 370-381
• 8 Buhl R, Berdel D, Criee CP. et al. [Guidelines for diagnosis and treatment of asthma patients]. Pneumologie 2006; 60: 139-177
• 9 Burburan SM, Xisto DG, Rocco PR. Anaesthetic management in asthma. Minerva Anestesiol 2007; 73: 357-365
• 10 Busse WW. Anti-immunoglobulin E (omalizumab) therapy in allergic asthma. Am J Respir Crit Care Med 2001; 164: 12-17
• 11 Caminati M, Caimmi C, Dama A. et al. What lies beyond Asthma Control Test: Suggestions for clinical practice. J Asthma 2016; 53: 559-562
• 12 Canet J, Gallart L. Postoperative respiratory failure: pathogenesis, prediction, and prevention. Curr Opin Crit Care 2014; 20: 56-62
• 13 Cassidy MR, Rosenkranz P, McCabe K. et al. I COUGH: reducing postoperative pulmonary complications with a multidisciplinary patient care program. JAMA Surg 2013; 148: 740-745
• 14 Choi SM, Lee J, Park YS. et al. Prevalence and global initiative for chronic obstructive lung disease group distribution of chronic obstructive pulmonary disease detected by preoperative pulmonary function test. PLoS One 2015; 10: e0115787
• 15 Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, Deutsche Gesellschaft für Innere Medizin, Deutsche Gesellschaft für Chirurgie. [Preoperative evaluation of adult patients prior to elective, non-cardiac surgery: joint recommendations of German Society of Anesthesiology and Intensive Care Medicine, German Society of Surgery and German Society of Internal Medicine]. Anaesthesist 2010; 59: 1041-1050
• 16 Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, Deutsche Gesellschaft für Innere Medizin, Deutsche Gesellschaft für Chirurgie. Präoperative Evaluation erwachsener Patienten vor elektiven, nicht kardiochirurgischen Eingriffen. Anästh Intensivmed 2010; 51: S788-S797
• 17 Fernandez-Bustamante A, Frendl G, Sprung J. et al. Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery: A Multicenter Study by the Perioperative Research Network Investigators. JAMA Surg 2017; 152: 157-166
• 18 Fields AC, Divino CM. Surgical outcomes in patients with chronic obstructive pulmonary disease undergoing abdominal operations: An analysis of 331,425 patients. Surgery 2016; 159: 1210-1216
• 19 Gaudry S, Vincent F, Rabbat A. et al. Invasive mechanical ventilation in patients with fibrosing interstitial neumonia. J Thorac Cardiovasc Surg 2014; 147: 47-53
• 20 Global Initiative for Chronic Obstructive Lung Disease (GOLD). At-a-Glance Outpatient Management Reference for Chronic Obstructive Pulmonary Disease (COPD). 2015.
• 21 Groeben H. Strategies in the patient with compromised respiratory function. Best Pract Res Clin Anaesthesiol 2004; 18: 579-594
• 22 Gronkjaer M, Eliasen M, Skov-Ettrup LS. et al. Preoperative smoking status and postoperative complications: a systematic review and meta-analysis. Ann Surg 2014; 259: 52-71
• 23 Guirguis-Blake JM, Senger CA, Webber EM. et al. Screening for Chronic Obstructive Pulmonary Disease: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2016; 315: 1378-1393
• 24 Guldner A, Kiss T, Serpa Neto A. et al. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers. Anesthesiology 2015; 123: 692-713
• 25 Halpin DM. Tiotropium in asthma: what is the evidence and how does it fit in?. World Allergy Organ J 2016; 9: 29
• 26 Harari S, Caminati A, Madotto F. et al. Epidemiology, survival, incidence and prevalence of idiopathic pulmonary fibrosis in the USA and Canada. Eur Respir J 2017;
• 27 Ie K, Yoshizawa A, Hirano S. et al. [A survey of perioperative asthmatic attack among patients with bronchial asthma underwent general anesthesia]. Arerugi 2010; 59: 831-838
• 28 Katsura M, Kuriyama A, Takeshima T. et al. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev 2015; (10) CD010356
• 29 Kiser TH, Vandivier RW. Severe acute exacerbations of chronic obstructive pulmonary disease: does the dosage of corticosteroids and type of antibiotic matter?. Curr Opin Pulm Med 2015; 21: 142-148
• 30 Kristensen SD, Knuuti J, Saraste A. et al. 2014 ESC/ESA 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 J Anaesthesiol 2014; 31: 517-573
• 31 Miravitlles M, Moragas A, Hernandez S. et al. Is it possible to identify exacerbations of mild to moderate COPD that do not require antibiotic treatment?. Chest 2013; 144: 1571-1577
• 32 Moore JA, Conway DH, Thomas N. et al. Impact of a peri-operative quality improvement programme on postoperative pulmonary complications. Anaesthesia 2017; 72: 317-327
• 33 Oka A, Hirano T, Yamaji Y. et al. Determinants of Incomplete Asthma Control in Patients with Allergic Rhinitis and Asthma. J Allergy Clin Immunol Pract 2017; 5: 160-164
• 34 Pavasini R, dʼAscenzo F, Campo G. et al. Cardiac troponin elevation predicts all-cause mortality in patients with acute exacerbation of chronic obstructive pulmonary disease: Systematic review and meta-analysis. Int J Cardiol 2015; 191: 187-193
• 35 Ramachandran SK, Nafiu OO, Ghaferi A. et al. Independent predictors and outcomes of unanticipated early postoperative tracheal intubation after nonemergent, noncardiac surgery. Anesthesiology 2011; 115: 44-53
• 36 Reddel HK, Bateman ED, Becker A. et al. A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J 2015; 46: 622-639
• 37 Zollinger A, Hofer CK, Kuhnle G, Schauer A, Schwender D, Schnoor J. Anästhesie bei Patienten mit Lungenerkrankungen. In: Rossaint R, Werner C, Zwißler B. Hrsg. Die Anästhesiologie. Berlin, Heidelberg: Springer; 2012: 1234-1250
• 38 Sasaki N, Meyer MJ, Eikermann M. Postoperative respiratory muscle dysfunction: pathophysiology and preventive strategies. Anesthesiology 2013; 118: 961-978
• 39 Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med 2006; 144: 581-595
• 40 Snowden CP, Prentis JM, Anderson HL. et al. Submaximal cardiopulmonary exercise testing predicts complications and hospital length of stay in patients undergoing major elective surgery. Ann Surg 2010; 251: 535-541
• 41 Tattersfield AE, Postma DS, Barnes PJ. et al. Exacerbations of asthma: a descriptive study of 425 severe exacerbations. The FACET International Study Group. Am J Respir Crit Care Med 1999; 160: 594-599
• 42 Van de Geijn GM, Denker S, Meuleman-van Waning V. et al. Evaluation of new laboratory tests to discriminate bacterial from nonbacterial chronic obstructive pulmonary disease exacerbations. Int J Lab Hematol 2016; 38: 616-628
• 43 Vogelmeier C, Buhl R, Criée CP. et al. Leitlinie der Deutschen Atemwegsliga und der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD). Pneumologie 2007; 61: 517
• 44 Walters JA, Tan DJ, White CJ. et al. Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2014; (12) CD006897
• 45 Warner DO. Preoperative smoking cessation: the role of the primary care provider. Mayo Clin Proc 2005; 80: 252-258
• 46 Waurick K, Van Aken H. Stellungnahme zur präoperativen Nikotinkarenz. Anästh Intensivmed 2013; 54: 488
• 47 Zwissler B, Reither A. [Preoperative abstinence from smoking. An outdated dogma in anaesthesia?]. Anaesthesist 2005; 54: 550-559