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Anästhesiol Intensivmed Notfallmed Schmerzther 2007; 42(3): 192-198
DOI: 10.1055/s-2007-974582
Fachwissen: Topthema: Geburtshilfliche Anästhesie

© Georg Thieme Verlag Stuttgart · New York

Nahrungskarenz im Kreißsaal - Ein traditioneller Qualitätsstandard auf dem Prüfstand

Preoperative Fasting in LabourJan-Philipp Breuer, Ingrid Correns, Claudia Spies
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Publication History

Publication Date:
16 March 2007 (online)

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Zusammenfassung

Von zahlreichen Fallberichten und Beobachtungsstudien wie die historisch einflussreichste von Curtis Mendelson über die Problematik der Säureaspirationspneumonitis rührte seit spätestens der 1940er Jahre die dogmatische Anwendung einer strengen Nahrungskarenz im Kreißsaal, um das Risiko schwangerer Frauen während Geburt und Entbindung zu reduzieren. Allerdings ist in den letzten Jahrzehnten sowohl die gesamte wie auch die speziell durch Aspirationszwischenfälle verursachte Müttersterblichkeit drastisch gefallen. Verantwortlich dafür sind die gleichzeitig erfolgten weit reichenden Fortschritte und Qualitätssprünge in der anästhesiologischen Versorgung, die die Bedeutung des Dogmas ,Nahrungskarenz' auch in der Geburtshilfe zunehmend kritisch hinterfragen lassen. Tatsächlich wurde bisher nie bewiesen, dass strenge Nüchternheit Morbidität und Mortalität senkt. Aufgrund der spezifischen physiologischen und anatomischen Veränderungen in der Schwangerschaft weisen Frauen theoretisch eine verlangsamte Magenpassage auf und werden daher noch häufig grundsätzlich als nicht nüchtern bewertet. Die Ergebnisse klinischer Studien, die unter verschiedenen Einflussfaktoren gastrale Residualvolumina gemessen haben, scheinen dieser Vorstellung jedoch zumindest hinsichtlich klarer Flüssigkeiten zu widersprechen oder bezweifeln deren klinische Relevanz. Jüngere Studien, die ohne offensichtliche Risikoerhöhung auf eine positive Beeinflussung des Patientinnenkomforts und Metabolismus von Mutter und Kind hindeuten, haben längst eine sinnvolle Diskussion über die Lockerung der Nahrungskarenz in der geburtshilflichen Medizin angeregt.

Summary

Numerous scientific case reports and observational studies, including that of Curtis Mendelson with its great historical relevance, have reported the problem of aspiration pneumonitis during labour. Because of this, strict fasting prior to delivery to reduce pulmonary aspiration has been doctrine since the 1940s. However, maternal mortality from anaesthesia, particularly from aspiration, has dropped dramatically over recent decades. This is due both to far-reaching improved quality of care as well as technical progress in anaesthesia, which increasingly challenge the scientific basis for fasting in obstetric anaesthesia. Strict fasting has never been proven to reduce morbidity or mortality in labouring women. Because of the physiological and anatomical changes of pregnancy, gastric emptying is theoretically prolonged, and therefore the risk of aspiration is assumed to be increased. However, the available data with patients receiving clear fluids run contrary to this assumption, or at least dispute its clinical relevance. Recent studies report positive influence of reduced fasting time on both maternal comfort and maternal/fetal metabolism without increased risk. This has already led to meaningful discussion regarding a corresponding change in official recommendations.

Schlüsselwörter

Aspiration - Nahrungskarenz - Entbindung - Magenpassage - Metabolismus

Keywords

aspiration - preoperative fasting - delivery - gastric emptying - metabolism

Kernaussagen

  • Die Fortschritte in der geburtshilflichen Anästhesie während der letzten Jahrzehnte haben die Aspiration zu einem seltenen Narkosezwischenfall und das Mendelson-Syndrom zu einem kalkulierbaren Risiko gemacht.

  • Der Zusammenhang strenge Flüssigkeitskarenz und reduzierte aspirationsassoziierte Morbidität und Mortalität konnte nie bewiesen werden. Für klare Flüssigkeiten ist bei unkomplizierter Entbindung die Magenpassage unbeeinflusst oder klinisch nicht relevant.

  • Erste Hinweise ergeben positive Einflüsse einer verkürzten Karenz für kohlenhydratreiche Trinklösungen auf mütterlichen wie fetalen Metabolismus. Die Frage nach einem signifikanten Effekt auf den Geburtsprozess und Morbidität muss weiter erforscht werden.

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Dr. med. Jan-Philipp Breuer

Email: philipp.breuer@charite.de

Dr. med. Ingrid Correns

Prof. Dr. med. Claudia D. Spies

Email: claudia.spies@charite.de

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