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„Tiefe Narkose – schlechte Narkose?“

Deep anesthesia, poorly tolerated anesthesia?

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Zusammenfassung

Neben tiefen Narkoseindexwerten wurden insbesondere Burst-Suppression-Muster und deren Zusammenhang mit postoperativem Delir und postoperativer Mortalität untersucht. Dreizehn der im Folgenden beschriebenen Studien aus dem letzten Jahrzehnt liefern Hinweise, dass dokumentierte tiefe Narkoseindizes oder Burst-Suppression-Muster das Risiko für entweder ein postoperatives kognitives Defizit oder die Mortalität erhöhen. Es handelt sich jedoch überwiegend um sekundäre Datenanalysen oder retrospektive Observationsstudien. Die erste prospektive Interventionsstudie zu „triple low“ konnte diesen Zusammenhang nicht nachweisen. Derzeit werden die ersten prospektiven Interventionsstudien zur Vermeidung exzessiver EEG-Suppression durchgeführt. Die Ergebnisse würden nicht nur die Formulierung evidenzbasierter Empfehlungen ermöglichen, sondern sollen auch Hinweise und Anhaltspunkte liefern, ob es sich bei den oben genannten Beobachtungen um einen kausalen Zusammenhang oder ein Epiphänomen handelt.

Abstract

Besides very low depth of anesthesia (DOA) index values, special intraoperative electroencephalography (EEG) patterns, such as burst suppression patterns and the correlation with postoperative delirium and mortality have been examined. Over the last decade the 13 studies described in this article yielded information that documented low DOA indices or burst suppression patterns increased the risk of either postoperative cognitive dysfunction or mortality; however, these were mainly secondary data analyses or retrospective observational studies. The first prospective interventional study regarding triple low could not confirm this correlation. Meanwhile, the first prospective interventional studies on avoidance of excessive EEG suppression are currently in progress. The results would not only enable the formulation of evidence-based recommendations but should also provide indicatíons and references as to whether the above mentioned observations can be explained by a causal association or an epiphenomenon.

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Danksagung

Die Autoren danken Dr. Matthias Kreuzer für die Diskussionen und Beiträge beim Erstellen dieses Manuskripts.

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Authors and Affiliations

  1. Klinikum rechts der Isar – Klinik für Anästhesiologie und Intensivmedizin, Fakultät für Medizin, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    M.-T. Georgii & G. Schneider

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  1. M.-T. Georgii
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  2. G. Schneider
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Correspondence to M.-T. Georgii.

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M.-T. Georgii und G. Schneider geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Georgii, MT., Schneider, G. „Tiefe Narkose – schlechte Narkose?“. Anaesthesist 68, 583–593 (2019). https://doi.org/10.1007/s00101-019-00647-y

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