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Intraoperatives chirurgisches Vorgehen

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Fast Track in der operativen Medizin

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Die Auswirkungen intraoperativer chirurgischer Maßnahmen auf den postoperativen Verlauf und die Rekonvaleszenz der Patienten sind sicherlich unumstritten. Eine atraumatische, schichtgerechte und anatomisch korrekte sowie blutungsarme Präparation ist die Grundlage jeder erfolgreichen operativen Behandlung. Diese Prinzipien der operativen Technik sind daher selbstverständlich und sollen im Folgenden nicht näher behandelt werden. Über diese allgemeinen Grundregeln hinaus gibt es jedoch zahlreiche weitere intraoperative chirurgische Vorgehensweisen, die den weiteren Verlauf des Patienten beeinflussen. Darunter fallen auch Maßnahmen, die bislang vielfach von den behandelnden Operateuren nicht ausreichend beachtet wurden, da sie oftmals dem Aufgabengebiet des Anästhesisten zugerechnet wurden. Tatsächlich sollten Maßnahmen, wie die Antibiotikaprophylaxe oder die Entfernung einer eventuell gelegten nasogastralen Sonde bei jedem Eingriff zwischen Chirurg und Anästhesist abgesprochen werden. An den entscheidenden Schnittstellen, wie der Übergabe der Patienten von der Station an den Operationsbereich oder die Rückverlegung von Patienten aus dem Aufwachraum auf die Station, können einfache Checklisten hilfreich sein und helfen Fehler zu vermeiden. Dies ist bei Anwendung eines Fast-track-Behandlungspfades besonders wichtig, weil auch kleine Unterlassungen den angestrebten optimalen Verlauf des Patienten beeinträchtigen können.

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Literatur

  • Akcali Y, Demir H, Tezcan B (2003) The effect of standard posterolateral versus muscle-sparing thoracotomy on multiple parameters. Ann Thor Surg 76:1050–1054

    Article  Google Scholar 

  • Barczynski M, Konturek A, Herman RM (2006) Superiority of preemptive analgesia with intraperitoneal instillation of bupivacaine before rather than after the creation of pneumoperitoneum for laparoscopic cholecystectomy: a randomized, double-blind, placebocontrolled study. Surg Endosc 20:1088–1093

    Article  PubMed  CAS  Google Scholar 

  • Basse L, Jakobsen D, Bardram L, et al. (2005) Functional recovery after open versus laparoscopic colonic resection. A randomized, blind study. Ann Surg 241:416–423

    Article  PubMed  Google Scholar 

  • Basse L, Thorbol JELK, Kehlet H (2004) Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 47:271–227

    Article  PubMed  Google Scholar 

  • Benedetti F, Vighetti S, Ricco C, Amanzio M et al. (1998) Neurophysiologic assessment of nerve impairment in posterolateral and muscle-sparing thoracotomy. J Thorac Cardiovasc Surg 115:841–847

    Article  PubMed  CAS  Google Scholar 

  • Bimston DN, McGee JP, Liptay MJ, Fry WA (1999) Continuous paravertebral extrapleural infusion for post-thoracotomy pain management. Surgery 126:650–656

    PubMed  CAS  Google Scholar 

  • Bisgaard et al. (1999) Multi-regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi-modal analgesia: a randomized, double-blinded, placebocontrolled study. Anaesth Analg 89:1017–1024

    Article  CAS  Google Scholar 

  • Borow M, Goldson HJ (1981) Postoperative venous thrombosis Evaluation of five methods of treatment. Am J Surg 141:245–251

    Article  PubMed  CAS  Google Scholar 

  • Borow M, Goldson HJ (1983) Prevention of postoperative deep venous thrombosis and pulmonary emboli with combined modalities. Am Surg 49:599–605

    PubMed  CAS  Google Scholar 

  • Böhm B, Neudecker J, Ruff J, Müller JM (1998) Visceralchirurgie 33:316–324

    Google Scholar 

  • Böhm B, Schwenk Wunghans T (2000) Das Pneumoperitoneum. Springer, Berlin Heidelberg New York

    Google Scholar 

  • Bund M, Heine J, Jaeger K (2005) Complications due to patient positioning: anaesthesiological considerations. Anasthesiol Intensivmed Notfallmed Schmerzther s40:329–339

    Article  Google Scholar 

  • Cerfolio RJ, Price TN, Bryant AS, Sale BC, Bartolucci AA (2003) Intracostal sutures decrease the pain of thoracotomy. Ann Thorac Surg 76:407–411

    Article  PubMed  Google Scholar 

  • Cheatham ML, Chapman WC, Key SP et al. (1995) A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy. Ann Surg 221:469–476

    Article  PubMed  CAS  Google Scholar 

  • Cuthbertson AM, McLeish AR, Penfold JC Ross H (1991) A comparison between single and double dose intravenous Timentin for the prophylaxis of wound infection in elective colorectal surgery. Dis Colon Rectum 34(2):151–155

    Article  PubMed  CAS  Google Scholar 

  • Daley MD (1997) Positioning and the geriatric surgical patient. Todays Surg Nurse 19:13–18

    PubMed  CAS  Google Scholar 

  • Dominguez-Fernandez E, Post S (2003) Abdominelle Drainagen. Chirurg 74:91–98

    Article  PubMed  CAS  Google Scholar 

  • Farthmann EH, Mappes HJ (1996) Der spannungsfreie Verschluss der Narbenhernie. Chirurg 67:310–316

    Google Scholar 

  • Frey DJ, Reichmann AK, Mauch H, Kaiser D (1993) »Single-shot« antibiotic prophylaxis in thoracic surgery; reduction of the postoperative infection rate. Infection 21(Suppl 1):35–44

    Article  Google Scholar 

  • Goldstein A, Grimault P, Henique A et al. (2000) Preventing postoperative pain by local anesthetic instillation after laparoscopic gynecologic surgery: a placebo-controlled comparison of bupivacaine and ropivacaine. Anesth Analg 91(2):403–407

    Article  PubMed  CAS  Google Scholar 

  • Grantcharov T, Rosenberg J (2001) Vertical compared with transverse incisions in abdominal surgery. Eur J Surg 167:260–267

    Article  PubMed  CAS  Google Scholar 

  • Guillou PJ, Quirke P, Thorpe H et al. (2005) Short-term endpoints of conventional versus laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  • Hakansson T, Raahave D, Hansen OH, Pedersen T (1993) Effectiveness of single dose prophylaxis with cefotaxime and metronidazole compared with three doses of cefotaxime alone in elective colorectal surgery. Eur J Surg 159:177–180

    PubMed  CAS  Google Scholar 

  • Hansberry KL, Thompson IM, Bauman J et al. (1991) A prospective comparison of thromboembolic stockings, external sequential pneumatic compression stockings and heparin sodium/dihydroergotamine mesylate for the prevention of thromboembolic complications in urological surgery. J Urology 145:1205–1208

    CAS  Google Scholar 

  • Hazelrigg SR, Landreneau RJ, Boley TM, Priesmeyer M, Schmaltz RA, Nawarawong W, Johnson JA, Walls JT, Curtis JJ (1991) The effect of muscle-sparing versus standard posterolateral thoracotomy on pulmonary-function, muscle strength, and postoperative pain. J Thor Cardiovasc Surg 101:394–401

    CAS  Google Scholar 

  • Hill NH, Pflug JJ, Jeyasingh K (1972) Prevention of deep vein thrombosis by intermittent pneumatic compression of the calf. Br Med J 1:131–135

    Article  Google Scholar 

  • Hoffmann S, Koller M, Plaul U et al. (2001) Nasogastric tube versus gastrostomy tube for gastric decompression in abdominal surgery: a prospective, randomized trial comparing patients’ tube-related inconvenience. Langenbecks Arch Surg 386:402–409

    Article  PubMed  CAS  Google Scholar 

  • Hussain SA, Hussain S (1988) Incisions with knife or diathermy and postoperative pain. Br J Surg 75:1179–1180

    Article  PubMed  CAS  Google Scholar 

  • Inaba T, Okinaga K, Fukushima R et al. (2004) Prospective randomized study of two laparotomy incisions for gastrectomy: midline incision versus transverse incision. Gastric Cancer 7:167–171

    Article  PubMed  Google Scholar 

  • Jensen LS, Andersen A, Fristrup SC et al. (1990) Br J Surg 77:513–518

    Article  PubMed  CAS  Google Scholar 

  • Kearns SR, Conolly EM, McNally S et al. (2001) Randomized controlled trial of diathermy versus scalpell incision in elective midline laparotomy. Br J Surg 88:41–44

    Article  PubMed  CAS  Google Scholar 

  • Kehlet H, Gray AW, Bonnet F, Camu F, Fischer HB, McCloy RF, Neugebauer EA, Puig MM, Rawal N, Simanski CJ (2005) A procedure-specific systematic review and consensus recommendations for postoperative analgesia following laparoscopic cholecystectomy. Surg Endosc 19:1396–1415

    Article  PubMed  CAS  Google Scholar 

  • Kienzle F, Ullrich W, Krier C (1997) Positioning trauma in anesthesia and surgical intensive care medicine. Anasthesiol Intensivmed Notfallmed Schmerzther 32:72–86

    Article  PubMed  CAS  Google Scholar 

  • Klinge U, Prescher A, Klosterhafen B et al. (1994) Pathophysiologie der Bauchdecker. Chirurg 68:293–303

    Article  Google Scholar 

  • Koebke J (1997) Anatomie der Bauchwand — Sollbruchstelle für Hernien. Zentralbl Chir 122:852–854

    PubMed  CAS  Google Scholar 

  • Lee JH, Hyung WJ, Noh SH (2002) Comparison of gastric cancer surgery with versus without nasogastric decompression. Yonsei Med J 43:451–456

    PubMed  Google Scholar 

  • Lumley JW, Siu SK, Pillay SP et al. (1992) Aust NZ J Surg 62:292–296

    Article  CAS  Google Scholar 

  • Monson JR, Guillou PJ, Keane FB et al. (1991) Cholecystectomy is safer without drainage: the results of a prospective, randomized clinical trial. Surgery 109:740–746

    PubMed  CAS  Google Scholar 

  • Moorjani N, Zhao F, Tian Y, Liang C, Kaluba J, Mainwand MO (2001) Effects of cryoanalgesia on post-thoracotomy pain and on the structure of intercostal nerve: a human prospective randomized trial and a histological study. Eur J Cardiothorac Surg 20:502–507

    Article  PubMed  CAS  Google Scholar 

  • Nelson R, Tse B, Edwards S (2005) Systematic review of prophylactic nasogastric decompression after abdominal operations. Br J Surg 92:673–680

    Article  PubMed  CAS  Google Scholar 

  • Nicolaides AN (1983) Intermittent sequential pneumatic compression of the legs and thrombo embolism—deterrent stockings in the prevention of postoperative deep venous thrombosis. Surgery 94:21–25

    PubMed  CAS  Google Scholar 

  • Ochroch EA, Gottschalk A, Augoustides JG, Aukburg SJ, Kaiser LR, Shrager JB (2002) Long-term pain and activity during recovery from major thoracotomy using thoracic epidural analgesia. Anesthesiology 97:1234–1244

    Article  PubMed  Google Scholar 

  • Ong C, Lirk P, Seymour RA et al. (2005) The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg 100:757–773

    Article  PubMed  Google Scholar 

  • Peiper C, Seelig M, Treutner KH, Schumpelick V (1997) Low-dose, singleshot perioperative antibiotic prophylaxis in colorectal surgery. Chemotherapy 43:54–59

    Article  PubMed  CAS  Google Scholar 

  • Petrowsky H, Demartines N, Rousson V et al. (2004) Evidence-based value of prophylactic drainage in gastrointestinal surgery. A systematic review and meta-analyses. Ann Surg 240:1074–1085

    Article  PubMed  Google Scholar 

  • Richardson J, Sabanathan S, Jones J, Shah RD, Cheema S, Mearns AJ (1999) A prospective, randomized comparison of preoperative and continuous balanced epidural or paravertebral bupivacaine on post-thoracotomy pain, pulmonary function and stress responses. Br J Anaesth 83:387–392

    PubMed  CAS  Google Scholar 

  • Roberts D, Pizzarelli G, Lepore V, al-Khaja N, Belboul A, Dernevik L (1988) Reduction of post-thoracotomy pain by cryotherapy of intercostal nerves. Scand J Thorac Cardiovasc Surg 22:127–130

    PubMed  CAS  Google Scholar 

  • Rucinski J, Margolis M, Panaqopoulos G, Wise L (2001) Closure of the abdominal midline fascia: meta-analysis delineates the optimal technique. Am Surg 67:421–426

    PubMed  CAS  Google Scholar 

  • Santora TA, Roslyn JJ (1993) Incisional hernia. Surg Clin North Am 73:557–570

    PubMed  CAS  Google Scholar 

  • Sauerland S, Lefering R, Neugebauer EA (2004) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev CD001546

    Google Scholar 

  • Schwenk W, Bohm B, Junghans T et al. (1998) Intermittent sequential compression of the lower limbs prevents venous stasis in laparoscopic and conventional colorectal surgery. Dis Colon Rectum 40:1056–1062

    Article  Google Scholar 

  • Schwenk W, Günther N, Haase O et al. (2003) Zentralbl Chir 128:1086–1092

    Article  PubMed  CAS  Google Scholar 

  • Schwenk W, Haase O, Neudecker J et al. (2005) Short term benefits for laparoscopic colorectal resection (Review). The Cochrane Library of Systematic Reviews Issue 2. Art. No.: CD003145.pub2.DOI: 10.1002/14651858

    Google Scholar 

  • Sienel W, Mueller J, Eggeling S, Thetter O, Passlick B (2005) Early chest tube removal after video-assisted thoracoscopic surgery. Results of a prospective randomized study. Chirurg 76:1155–1160

    Article  PubMed  CAS  Google Scholar 

  • Squirrel DM, Majeed AW, Troy G, Peacock JE, Nicholl JP, Johnson AG (1998) A randomized, prospective, blinded comparison of postoperative pain, metabolic response and perceived health after laparoscopic and small incision cholecystectomy. Surgery 123:485–495

    Article  Google Scholar 

  • Tanos V, Rojansky N (1994) Prophylactic antibiotics in abdominal hysterectomy. J Am Coll Surg 179:593–600

    PubMed  CAS  Google Scholar 

  • The Colon Cancer Open or Laparoscopic Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484

    Article  Google Scholar 

  • Tovar EA (2001) One-day admission for major lung resections in septuagenarians and octogenarians: a comparative study with a younger cohor. Eur J Cardiothorac Surg 20:449–453

    Article  PubMed  CAS  Google Scholar 

  • Tschernko EM, Hofer S, Bieglmayer C, Wisser W, Haider W (1996) Early postoperative stress: video-assisted wedge resection/lobectomy vs conventional axillary thoracotomy. Chest 109:1636–1642

    Article  PubMed  CAS  Google Scholar 

  • Ullrich W, Biermann E, Kienzle F, Krier C (1997) Damage due to patient positioning in anesthesia and surgical medicine. Anasthesiol Intensivmed Notfallmed Schmerzther 32(1):4–20

    Article  PubMed  CAS  Google Scholar 

  • Urbach DR, Kennedy ED, Cohen MM (1999) Colon and rectal anastomoses do not require routine drainage: a systematic review and metanalysis. Ann Surg 229:174–180

    Article  PubMed  CAS  Google Scholar 

  • Vanek VW (1998) Meta-analysis of effectiveness of intermittent pneumatic compression devices with a comparison of tigh-high to knee-high sleeves. Am Surg 64:1050–1058

    PubMed  CAS  Google Scholar 

  • Virchow R (1856) Phlogose und Thrombose im Gefäßsystem. Gesammelte Abhandlungen zur wissenschaftlichen Medicin 3:458–635

    Google Scholar 

  • Weissauer W (2002) Determining responsibility for surgical positioning of the patient and malpractice for damage caused by patient position. Unfallchirurg 105:404–412

    Article  PubMed  CAS  Google Scholar 

  • Winfree CJ, Kline DG (2005) Intraoperative positioning nerve injuries. Surg Neurol 63:5–18

    Article  PubMed  Google Scholar 

  • Yoo CH, Son BH, Han WK et al. (2002) Nasogastric Decompression is not Necessary in Operations for Gastric Cancer: Prospective Randomised Trial. Eur J Surg 168:379–383

    Article  PubMed  Google Scholar 

  • Zippel R, Gastinger I, Lippert H (2002) In: Köckerling F, Lippert H, Gastinger I (eds) Fortschritte in der kolorektalen Chirurgie. Science Med, Hannover, S 99–107

    Google Scholar 

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Authors and Affiliations

  1. Universitätsklinik für Allgemein, Visceral-, Gefäß- und Thoraxchirurgie, Universitätsmedizin Berlin-Charité, Campus Mitte Charitéplatz 1, 10117, Berlin

    J. Neudecker Dr. med.

  2. Park-Klinik Weissensee Anästhesiologie, Intensivmedizin, Schönstraße 80, 13086, Berlin

    M. Hensel Priv.-Doz. Dr. med.

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  1. J. Neudecker Dr. med.
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  2. M. Hensel Priv.-Doz. Dr. med.
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Neudecker, J., Hensel, M. (2009). Intraoperatives chirurgisches Vorgehen. In: Fast Track in der operativen Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-39709-0_4

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  • DOI: https://doi.org/10.1007/978-3-540-39709-0_4

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