Zusammenfassung
Die Einleitungsphase ist infolge der atemdepressorischen Wirkung aller Injektions- und Inhalationsanästhetika einer der kritischen Abschnitte im Verlauf einer Narkose. Der Patient ist dabei jedoch zunächst weniger durch das Auftreten einer Hypoventilation mit konsekutiver Hyperkapnie gefährdet, sondern vielmehr durch die gleichzeitig einsetzende und sich wesentlich schneller ausprägende Hypoxie. Die Verwendung einer gegenüber Raumluft (FIO2 = 0,21) im Atembzw. Beatmungsgas erhöhten inspiratorischen Sauerstofffraktion (FIO2 > 0,33) bei der Narkoseeinleitung trägt diesem Umstand Rechnung. Bei Einleitung einer Intubationsnarkose kommt erschwerend dazu, daß der Patient
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während des Intubationsvorgangs apnoisch ist und
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die Dauer des Intubationsvorgangs nicht sicher vorhersehbar ist.
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Literatur
Baraka AS, Hanna MT, Jabbour SI, Nawfal MF, Sibai AAN, Yazbeck VG, Khoury NI, Karam KS (1992) Preoxygenation of pregnant and nonpregnant women in the head-up versus supine position. Anesth Analg 74 : 757–759
Bartlett RG, Brunbach HF, Specht H (1959) Demonstration of aventilatory mass flow during ventilation and apnea in man. J Appl Physiol 14:97
Berthoud MC, Peacock JE, Reilly CS (1991) Effectiveness of preoxygenation in morbidly obese patients. Br J Anaesth 67: 464–466
Brandt L (1990) The significance of the mixed venous O2 status as a complement of the arterial O2 status. In: Zander R, Mertzlufft F (eds) The oxygen status of arterial blood. Karger, Basel, pp 238–263
Brandt L, Metzlufft FO, Rudlof B, Dick W (1988) In-vivo-Nachweis de Christiansen-Douglas-Haldane-Effektes unter klinischen Bedingungen. Anaesthesist 37: 529–534
Brandt L, Mertzlufft F, Dick W (1989) Verhalten des arteriellen und gemischtvenösen Blutgasstatus in der Initialphase der Intubationsapnoe. Anaesthesist 38: 167–173
Braun U, Hudjetz W (1980) Dauer der Präoxygenation bei Patienten mit regelrechter und gestörter Lungenfunktion. Anaesthesist 29: 125–131
Carmichael FJ, Cruise CJE, Crago RR, Paluck S (1989) Preoxygenation: A study of denitrogenation. Anesth Analg 68: 406–409
Cheniack NS, Longobardo GS (1970) Oxygen and carbon dioxid gas stores of the body. Physiol Rev 50: 196–243
Christiansen J, Douglas CG, Haldane JS (1914) The absorption and dissociation of carbon dioxide by human blood. J Physiol 48: 244–271
Cormack RS, Lehane J (1984) Difficult tracheal intubation in obstetrics. Anaesthesia 39: 1105–1111
Draper WB, Whitehead RW (1944) Diffusion respiration in the dog anesthetized by pentothal sodium. Anesthesiology 5: 262–273
Drummond GB, Park GR (1984) Arterial oxygen saturation before intubation of the trachea. An assessment of oxygenation techniques. Br J Anaesth 56: 987–993
Duda D, Brandt L, Rudlof B, Mertzlufft F, Dick W (1988) Der Einfluß unterschiedlicher Präoxygenationsverfahren auf den arteriellen Sauerstoffstatus. Anaesthesist 37: 408–412
Dudel J (1990) Grundlagen der Zellphysiologie. In: Schmidt RF, Thews G (Hrsg) Physiology des Menschen. Springer, Berlin Heidelberg New York Tokyo, S 2–19
Falke KJ (1988) Therapiebedürftige Grenzwerte akuter Änderungen des arteriellen O2-Parti- aldruckes. In: Zander R, Mertzlufft F (Hrsg) Der Sauerstoffstatus des arteriellen Blutes. Karger, Basel, S 65–73
Fraioli RL, Sheffer LA, Steffenson JL (1973) Pulmonary and cardiovascular effects of apneic oxygenation in man. Anesthesiology 39: 588–596
Freemann LJ, Nixon PGF (1984) Are coronary artery spasm and progressive damage to the heart associated with hyperventilation syndrome? Br Med J 291: 851–853
Frumin MJ, Epstein RM, Cohen G (1959) Apneic oxygenation in man. Anesthesiology 20: 789–798
Gabrielsen J, Valentin N (1982) Routine induction of anaesthesia with thiopental and suxamethonium: Apnoea without ventilation? Acta Anaesth Scand 26: 59–62
Gambee AM, Hertzka RE, Fisher DM (1987) Pre-oxygenation techniques: Comparison of three minutes and four breaths. Anesth Analg 66: 468–470
Gold MI (1989) Pre-oxygenation. Br J Anaesth 62: 241–242
Gold MI, Duarte I, Muravchick S (1981) Arterial oxygenation in conscious patients after 5 minutes and after 30 seconds of oxygen breathing. Anesth Analg 60: 313–315
Goldberg ME, Norris MC, Larijani GE, Marr AT, Seltzer JL (1989) Preoxygenation in the morbidly obese: A comparison of two techniques. Anesth Analg 68: 520–522
Guyton AC (1991) Textbook of medical physiology. Saunders, Philadelphia
Haab P, Piiper J, Rahn H (1960) Attempt to demonstrate the distribution component of the alveolar-arterial oxygen pressure difference. J Appl Physiol 15: 235–240
Hamilton WK, Eastwood DW (1955) A study of denitrogenation with some inhalation anesthetic systems. Anesthesiology 16: 861–867
Hedley-Whyte J, Laver MB, Bendixen HH (1964) Effect of changes in tidal ventilation on physiologic shunting. Am J Physiol 206: 891–897
Heller ML, Watson TR, Imredy DS (1964) Apneic oxygenation in man: Polarographie arterial oxygen tensin study. Anesthesiology 25: 25–30
Holmdahl MH (1956) Pulmonary uptake of oxygen, acid-base metabolism, and circulation during prolonged apnoea. Acta Chir Scand 212 [Suppl]: 1–128
Jense HG, Dubin SA, Silverstein PI, O’Leary-Escolas U (1991) Effect of obesity on safe duration of apnea in anesthetized humans. Anesth Analg 72: 89–93
Kelman GR, Nunn JF, Prys-Roberts C, Greenbaum R (1967) The influence of cardiac output on arterial oxygenation: A theoretical study. Br J Anaesth 39: 450–458
Kettler D, Sonntag H (1971) Apnoische Oxygenation unter Verwendung von Trispuffer. Anaesthesist 20: 94–98
Khoo ST, Woo M, Kumar A (1993) Preoxygenation techniques: the value of nitrous oxide. Acta Anaesth Scand 37: 23–25
Kreimeier U, Meßmer K (1988) Differentialdiagnose der arteriellen Hypoxämie. In: Zander R, Mertzlufft F (Hrsg) Der Sauerstoffstatus des arteriellen Blutes. Karger, Basel, S 194–200
Krogh A (1910) On the mechanism of the gas exchange in the lungs. Scand Arch Physiol 23: 248–278
Krogh A (1941) The comparative physiology of respiratory mechanisms. University of Pennsylvania Press, Philadelphia
Kung MG, Hung CT, Ng KP (1991) Arterial desaturation during induction in healthy adults: should preoxygenation be a routine? Anaesth Intensive Care 19: 192–196
Lowe DM, McFadzean W (1991) Drawover anaesthesia and preoxygenation. Br J Anaesth 66: 196–199
Maurette P, O’Flaherty D, Adams AP (1993) Pre-oxygenation: an easy method for all elective patients. Eur J Anaesth 10: 413–417
McCrory JW, Matthews JNS (1990) Comparison of four methods of preoxygenation. Br J Anaesth 64: 571–576
Merkelbach D, Brandt L, Metzlufft F (1993) Verhalten der arteriellen und gemischtvenösen Sauerstoff- und Kohlendioxidpartialdrücke sowie der pH-Werte während und nach einer Intubationsapnoe. Anaesthesist 42: 691–701
Mertzlufft F (1993) System zur Oxygenierung von Patienten durch Nutzung des intrapulmonalen Sauerstoffspeichers. Habilitationsschrift, Homburg-Saar
Michel CC (1968) The buffering behaviour of blood during hypoxaemia and respiratory exchange: Theory. Respiration Physiol 4: 283–291
Nahas GG (1956) Influence of acute hypoxia on pulmonary circulation of dogs during apnea. Fed Proc 15–134
Niemer, Nemes C (1979) Veno-Arterieller Shunt, Verschlußvolumen (Closing Volume)-Ver- schlußkapazität. Datenbuch Intensivmedizin. Gustav Fischer, Stuttgart New York, S 41–49
NN (1667) An account of an experiment made by M. Hook, of preserving animals alive by blowing through their lungs with bellows. Philosophical Transactions 2: 539–540
Norris MC, Dewan DM (1985) Preoxygenation for cesarean section: A comparison of two techniques. Anesthesiology 621: 827–829
Nunn JF (1993) Applied respiratory physiology. Butterworth, London
Ooi R, Pattison J, Joshi P, Chung R, Soni N (1992) Pre-oxygenation: the Hudson mask as an alternative technique. Anaesthesia 47: 974–976
Ooi R, Joshi P, Soni N (1992) A high flow semi-open system for preoxygenation: an evaluation. Br J Anaesth 68: 39–42
Rehder K, Marsh HM (1980) Gas exchange during anesthesia. In: West JB (ed) Pulmonary gas exchange. Vol II. Academic Press, New York, pp 149–185
Reinhardt K, Specht M, Föhring U, Mayr O, Eyrich K (1989) Einfluß der Präoxygenierung auf Hämodynamik und Sauerstoffverbrauch, Anaesthesist 38: 233–237
Russell GN, Smith CL, Snowdon SL, Bryson THL (1987) Pre-oxygenation and the parturient patient. Anaesthesia 42: 346–351
Russell IF, Chambers WA (1981) Closing volume in normal pregnancy. Br J Anaesth 53 : 1043–1047
Teller LE, Alexander CM, Frumin MJ, Gross JB (1988) Pharyngeal insufflation of oxygen prevents arterial desaturation during apnea. Anesthesiology 69: 980–982
Thews G (1990) Lungenatmung. In: Schmidt RF, Thews G (Hrsg) Physiologie des Menschen. Springer, Berlin Heidelberg New York Tokyo, S 574–610
Thews G (1990) Atemgastransport und Säure-Basen-Status des Blutes. In: Schmidt RF, Thews G (Hrsg) Physiologie des Menschen. Springer, Berlin Heidelberg New York Tokyo, S 611–632
Thorpe CM, Gauntlett IS (1990) Arterial oxygen saturation during induction of anaesthesia. Anaesthesia 45: 1012–1015
Valentine SJ, Marjot R, Monk CR (1990) Preoxygenation in the elderly: A comparison of the four-maximal-breath and three-minute techniques. Anesth Analg 71: 516–519
Vesalius A (1542) De humani corporis fabrica libri septem; 7. Buch, Kap. XIX. Basel, Johannes Oporinus, S 658–663
Videira RLR, Neto PPR, Gomide DO (1992) Pre-oxygenation in children: for how long? Acta Anaesth Scand 36: 109–111
Volhard F (1908) Über künstliche Atmung durch Ventilation der Trachae und eine einfache Vorrichtung zur rhythmischen künstlichen Atmung. Münch Med Wochenschr 55: 209–211
Wilson IH, Van Heerden PV, Leigh J (1990) Domicilary Oxygen Concentrators in anaesthesia : Preoxygenation techniques and inspired oxygen concentrations. Br J Anaesth 65: 342–345
Zander R (1991) The oxygen status of arterial human blood. In: Zander R, Mertzlufft F (eds) The oxygenstatus of arterial blood. Karger, Basel, pp 1–13
Zander R, Mertzlufft F (1992) Clinical use of oxygen stores: Pre-oxygenation and apneic oxygenation. Adv Exp Med Biol 317: 413–420
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Brandt, L., Merkelbach, D., Rudlof, B. (1994). Sauerstoffversorgung bei Narkoseeinleitung. In: Aktuelles Wissen für Anästhesisten. Refresher Course, vol 20. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-78786-7_4
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