Entwicklung der anästhesieassoziierten Letalität und Einfluss auf das Outcome

Zusammenfassung

Die anästhesieassoziierte Letalität konnte in den letzten Jahrzehnten deutlich gesenkt werden. Dies ermöglicht neben einer zuverlässigen Monitoringtechnik gut ausgebildetes Personal, das die patienten- und eingriffsspezifischen Risiken in das intraoperative Management mit einbezieht. Die richtige postoperative Betreuung von Patienten in Aufwachraum, PACU und Intensivstation ist ein weiterer zentraler Punkt für ein verbessertes Patienten-Outcome.

Abstract

Achievements in anaesthesiology form the basis for the tremendous development of surgical therapy. Reliable monitoring technology, which is scrutinized on a regular basis using checklists, is allowing anaesthesia at the borders of physiology. During the last decades, anaesthesia-related mortality has been decreasing considerably. Well-trained anaesthesiology staff, who considers patient- and procedure-specific risks in anaesthetic management, is of major importance. Furthermore, postoperative care in specialised units and intensive care wards is a key factor of improved patient outcome after surgery. In the future, unravelling the interactions of anaesthesia, surgical trauma and postoperative complications will further contribute to improved patient safety.

Kernaussagen

• Bezüglich des perioperativen Patienten-Outcomes unterscheidet man die anästhesiebedingte, die anästhesieassoziierte und die perioperative Letalität.

• Leider existieren aktuell keine einheitlichen Definitionen dieser 3 Begriffe, was einen Vergleich unterschiedlicher Studien erschwert.

• Eine vielzitierte Studie aus dem Jahr 2012 (Bainbridge et al.) konnte einen eindrucksvollen Rückgang der anästhesieassoziierten Letalität über die letzten Jahrzehnte belegen.

• Die Letalität steigt exponentiell mit dem ASA-Status des Patienten.

• Zu den wichtigsten Faktoren, die das perioperative Risiko beeinflussen, zählen patienten-, eingriffs-und prozessspezifische Faktoren.

• Eine gute Ausbildung des anästhesiologischen Personals, eine individuelle Risikostratifizierung des Patienten, multimodales Monitoring sowie die Anwendung von Leitlinien und Checklisten können zur Risikoreduktion beitragen.

Schlüsselwörter

anästhesiebedingte Letalität - anästhesieassoziierte Letalität - perioperative Letalität

Key words

anaesthesia-caused mortality - anaesthesia-related mortality - perioperative mortality

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