Anästhesiologisches Management bei Schädel-Hirn-Trauma

Beim Schädel-Hirn-Trauma führt eine äußere Gewalteinwirkung auf den Kopf zu einer Funktionsstörung des Gehirns. Die Schwere dieser Hirnverletzung bestimmt maßgeblich die Prognose der Patienten. Dabei ist das Ausmaß der primären Hirnschädigung durch den Anästhesisten nicht mehr beeinflussbar. Ein optimales anästhesiologisches Management kann aber dazu beitragen, dass Folgeschäden – die sog. sekundäre Hirnschädigung – vermieden oder minimiert werden.

Abstract

Traumatic brain injury (TBI) is the main cause of death in people < 45 years in industrial countries. Minimising secondary injury to the injured brain is the primary goal throughout the entire treatment. Anaesthesiologic procedures aim at the reconstitution of cerebral perfusion and homeostasis. Both TBI itself as well as accompanying injuries show effects on cardiac and pulmonary function. Time management plays a crucial role in ensuring a safe anaesthesiologic environment while minimizing unnecessary procedures. Furthermore, growing medical drug pre-treatment demands for further knowledge e.g., in antagonization of anticoagulation.

Kernaussagen

• Ein optimales anästhesiologisches Management von SHT-Patienten kann dazu beitragen, die sekundäre Hirnschädigung zu minimieren.

• Das SHT wird anhand der Glasgow Coma Scale in die 3 Schweregrade leicht (13–15 Punkte), mittelschwer (9–12 Punkte) und schwer (3–8 Punkte) eingeteilt.

• 60% der Patienten mit mittelschwerem und schwerem SHT weisen relevante extrakranielle Verletzungen auf. Über die Hälfte der Polytraumapatienten leidet an einem begleitenden SHT.

• Das Notfallmonitoring sollte mindestens aus nichtinvasiver Blutdruckmessung, peripherer Sauerstoffsättigung und Herzfrequenz bestehen, eine invasive Blutdruckmessung sollte schnellstmöglich etabliert werden.

• Bei Fehlen akuter Herniationstendenz gilt als Beatmungsziel eine Normokapnie (PaCO₂ 36–42 mmHg).

• Zur Prävention der sekundären Hirnschädigung müssen Hypotonie und Hypoxie konsequent therapiert werden.

• Das SHT kann eigenständiger Auslöser relevanter Funktionsstörungen in nicht neurologischen Organsystemen wie Herz-Kreislauf, Lunge und Gerinnungssystem sein.

• SHT-Patienten benötigen eine engmaschige Gerinnungsdiagnostik und ein zielgerichtetes Gerinnungsmanagement. Hierzu kann das Standardlabor durch die Point-of-Care-Thrombelastometrie ergänzt werden.

Schlüsselwörter

Schädel-Hirn-Traum - Hirndruck - zerebraler Perfusionsdruck - anästhesiologische Behandlung - Gerinnungsmanagement

Keywords

traumatic brain injury - intracranial pressure - cerebral perfusion - anaesthesiological treatment - coagulation management

Publication History

Article published online:
29 July 2024

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