Zusammenfassung
Die Kenntnis von Pathophysiologie und dem spezifischen Einfluss auf das anästhesiologische
Vorgehen ist für den betreuenden Anästhesisten bei Kindern mit angeborenen Herzfehlern
von großer Bedeutung. Häufig bestimmen eingeschränkte Grenzen der hämodynamischen
Stabilität das Vorgehen. Die große Herausforderung für den Anästhesisten besteht in
der Aufrechterhaltung einer intraoperativen Homöostase bei verschiedensten operativen
Eingriffen. Links-Rechts-Shunts führen zur linksventrikulären Volumenbelastung, welche
häufig mit einem pulmonalen Hypertonus einhergeht. Rechts-Links-Shunts verursachen
eine zentrale Zyanose.
Abstract:
Anesthesiologists involved in the care of children with congenital heart disease (CHD)
have to understand the pathophysiology of each cardiac lesion and anticipate the impact
of the planned procedure. Often the dimished margin of hemodynamic stability determines
the guidelines of care. In children with CHD maintainance of the homeostasis during
anesthesia for a wide variety of procedures is the anesthesiologist`s challenge. Left-to-right
shunting means a volume load to the left ventricle frequently combined with pulmonary
hypertension. Right-to-left shunting leads to a central cyanosis.
Schlüsselwörter:
Anästhesie - angeborene Herzfehler - FallotŽsche Tetralogie - Transposition der großen
Arterien - HLHS
Keywords:
Anesthesia - Congenital heart disease - Tetralogy of Fallot - HLHS - Transposition
of the great arteries
Kernaussagen
-
Die Narkoseführung bei Kindern mit kongenitalen Vitien bedarf einer guten Kenntnis
der Pathophysiologie und Hämodynamik des jeweiligen Herzfehlers.
-
Bei Shuntvitien mit LR-Shunt kommt es zur Volumenbelastung des linken Ventrikels.
Bei Shunts auf Ventrikelebene oder auf Ebene der großen Gefäße kann ein pulmonaler
Hypertonus auftreten.
-
RL-Shunts führen zu einer zentralen Zyanose. Besondere Sorgfalt ist wegen der akzidentiellen
Luftembolie bei intravenösen Injektionen geboten.
-
Bei turbulenten intrakardialen Flussmustern wie Shuntvitien, Klappenstenosen oder
-insuffizienzen sowie bei komplexen Vitien ist ggf. eine Endokarditisprophylaxe durchzuführen.
-
Patienten mit cavopulmonalen Anastomosen reagieren bei einer Erhöhung des PVR mit
Absinken von Sättigung und HZV.
-
Alle Maßnahmen, die eine Senkung des PVR induzieren, tragen zur Stabilisierung in
einer solchen Situation bei.
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Dr. med. Peter Dütschke
Email: Peter.Duetschke@uk-sh.de
Dr. med. Jens Scheewe
Email: Jens.Scheewe@uk-sh.de
PD Dr. med. Berthold Bein
Email: bein@anaesthesie.uni-kiel.de
