Skip to main content
SpringerLink
Log in

Anästhesie bei Patienten mit Erkrankungen von Herz und Kreislauf: Allgemeine Prinzipien

  • Living reference work entry
  • First Online:
Die Anästhesiologie

Part of the book series: Springer Reference Medizin ((SRM))

  • 610 Accesses

Zusammenfassung

Erkrankungen von Herz und Kreislauf gehören mit einer Prävalenz von etwa 25 % zu den häufigsten Erkrankungen in Industrienationen. Evaluation, Narkoseführung, Monitoring und postoperative Versorgung kardiovaskulärer Risikopatienten weisen trotz der z. T. sehr unterschiedlichen Pathophysiologie der verschiedenen Erkrankungen viele Gemeinsamkeiten auf. Zunächst werden daher die allgemeinen Prinzipien des anästhesiologischen Vorgehens bei kardiovaskulär kranken Patienten besprochen.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Literatur

  1. Anonymus (1997) Guidelines for assessing and managing the perioperative risk from coronary artery disease associated with major noncardiac surgery. American College of Physicians. Ann Intern Med 127:309–312

    Google Scholar 

  2. Lee TH, Marcantonio ER, Mangione CM et al (1999) Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 100:1043–1049

    CAS  PubMed  Google Scholar 

  3. Rohde LE, Polanczyk CA, Goldman L et al (2001) Usefulness of transthoracic echocardiography as a tool for risk stratification of patients undergoing major noncardiac surgery. Am J Cardiol 87:505–509

    CAS  PubMed  Google Scholar 

  4. Eagle KA, Berger PB, Calkins H et al (2002) ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery. Circulation 105:1257–1267

    PubMed  Google Scholar 

  5. Reilly DF, McNeely MJ, Doerner D et al (1999) Self-reported exercise tolerance and the risk of serious perioperative complications. Arch Intern Med 159:2185–2192

    CAS  PubMed  Google Scholar 

  6. Ryding AD, Kumar S, Worthington AM, Burgess D (2009) Prognostic value of brain natriuretic peptide in noncardiac surgery: a meta-analysis. Anesthesiology 111:311–319

    CAS  PubMed  Google Scholar 

  7. Schlitt A, Reindl I, Ebelt H et al (2011) Cardiac biomarkers in perioperative medicine: significance for noncardiac surgery patients. Anaesthesist 60:709–716

    CAS  PubMed  Google Scholar 

  8. DGAI, DGC, DGIM (2017) Preoperative evaluation of adult patients prior to elective, non-cardiac surgery: joint recommendations of German society of anesthesiology and intensive care medicine, German society of surgery and German society of internal medicine. Anaesthesist

    Google Scholar 

  9. Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert SD, Ford I, Gonzalez-Juanatey JR, Gorenek B, Heyndrickx GR, Hoeft A, Huber K, Iung B, Kjeldsen KP, Longrois D, Lüscher TF, Pierard L, Pocock S, Price S, Roffi M, Sirnes PA, Sousa-Uva M, Voudris V, Funck-Brentano C, Authors/Task Force Members (2014) 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: the joint task force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J 35(35):2383–2431

    PubMed  Google Scholar 

  10. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, Wijeysundera DN (2014) 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation 130(24):2215–2245

    PubMed  Google Scholar 

  11. Farid I, Litaker D, Tetzlaff JE (2002) Implementing ACC/AHA guidelines for the preoperative management of patients with coronary artery disease scheduled for noncardiac surgery: effect on perioperative outcome. J Clin Anesth 14:126–128

    PubMed  Google Scholar 

  12. Fleisher LA, Beckman JA, Brown KA et al (2007) ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. Circulation 116:1971–1996

    PubMed  Google Scholar 

  13. DGAI, DGC, DGIM (2010) Preoperative evaluation of adult patients prior to elective, non-cardiac surgery: joint recommendations of German Society of Anesthesiology and Intensive Care Medicine, German Society of Surgery and German Society of Internal Medicine. Anaesthesist 59:1041–1050

    Google Scholar 

  14. Stevens RD, Burri H, Tramer MR (2003) Pharmacologic myocardial protection in patients undergoing noncardiac surgery: a quantitative systematic review. Anesth Analg 97:623–633

    PubMed  Google Scholar 

  15. Wijeysundera DN, Beattie WS (2003) Calcium channel blockers for reducing cardiac morbidity after noncardiac surgery: a meta-analysis. Anesth Analg 97:634–641

    CAS  PubMed  Google Scholar 

  16. Bertrand M, Godet G, Meersschaert K et al (2001) Should the angiotensin II antagonists be discontinued before surgery? Anesth Analg 92:26–30

    CAS  PubMed  Google Scholar 

  17. Boccara G, Ouattara A, Godet G et al (2003) Terlipressin versus norepinephrine to correct refractory arterial hypotension after general anesthesia in patients chronically treated with renin-angiotensin system inhibitors. Anesthesiology 98:1338–1344

    CAS  PubMed  Google Scholar 

  18. Meersschaert K, Brun L, Gourdin M et al (2002) Terlipressin-ephedrine versus ephedrine to treat hypotension at the induction of anesthesia in patients chronically treated with angiotensin converting-enzyme inhibitors: a prospective, randomized, double-blinded, crossover study. Anesth Analg 94:835–840

    CAS  PubMed  Google Scholar 

  19. Schirmer U, Schürmann W (2007) Preoperative administration of angiotensin-converting enzyme inhibitors. Anaesthesist 56:557–561

    CAS  PubMed  Google Scholar 

  20. Johannes CB, Koro CE, Quinn SG et al (2007) The risk of coronary heart disease in type 2 diabetic patients exposed to thiazolidinediones compared to metformin and sulfonylurea therapy. Pharmacoepidemiol Drug Saf 16:504–512

    CAS  PubMed  Google Scholar 

  21. Cekmen N, Cesur M, Cetinbas R et al (2006) Acute pulmonary edema due to rosiglitazone use in a patient with diabetes mellitus. J Intensive Care Med 21:47–50

    PubMed  Google Scholar 

  22. Duncan AI, Koch CG, Xu M et al (2007) Recent metformin ingestion does not increase in-hospital morbidity or mortality after cardiac surgery. Anesth Analg 104:42–50

    CAS  PubMed  Google Scholar 

  23. Le MY, Godet G, Coriat P et al (2007) The impact of postoperative discontinuation or continuation of chronic statin therapy on cardiac outcome after major vascular surgery. Anesth Analg 104:1326–1333

    Google Scholar 

  24. Tuman KJ, McCarthy RJ, O’Connor CJ et al (1996) Aspirin does not increase allogeneic blood transfusion in reoperative coronary artery surgery. Anesth Analg 83:1178–1184

    CAS  PubMed  Google Scholar 

  25. Yusuf S, Zhao F, Mehta SR et al (2001) Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 345:494–502

    CAS  Google Scholar 

  26. Neilipovitz DT, Bryson GL, Nichol G (2001) The effect of perioperative aspirin therapy in peripheral vascular surgery: a decision analysis. Anesth Analg 93:573–580

    CAS  PubMed  Google Scholar 

  27. Davies SJ, Wilson RJ (2004) Preoperative optimization of the high-risk surgical patient. Br J Anaesth 93:121–128

    CAS  PubMed  Google Scholar 

  28. Gurgel ST, do Nascimento NP Jr (2011) Maintaining tissue perfusion in high-risk surgical patients: a systematic review of randomized clinical trials. Anesth Analg 112:1384–1391

    PubMed  Google Scholar 

  29. Hamilton MA, Cecconi M, Rhodes A (2011) A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg 112:1392–1402

    PubMed  Google Scholar 

  30. Wiebalck A, Möllhoff T, Hachenberg T et al (2002) Perioperative Optimierung des Sauerstoffangebots bei Hochrisikopatienten. Anästhesiol Intensivmed 43:327–339

    Google Scholar 

  31. Woehlck HJ, Conolly LA, Cinquegrani M et al (1999) Acute smoking increases ST depression in humans during general anesthesia. Anest Analg 89:856–860

    CAS  Google Scholar 

  32. Hebert PC, Yetisir E, Martin C et al (2001) Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases? Crit Care Med 29:227–234

    CAS  PubMed  Google Scholar 

  33. Spiess BD, Ley C, Body SC et al (1998) Hematocrit value on intensive care unit entry influences the frequency of Q-wave myocardial infarction after coronary artery bypass grafting. J Thorac Cardiovasc Surg 116:460–467

    CAS  PubMed  Google Scholar 

  34. Rao SV, Jollis JG, Harrington RA et al (2004) Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes. JAMA 292:1555–1562

    CAS  PubMed  Google Scholar 

  35. Wu WC, Rathore SS, Wang Y et al (2001) Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med 345:1230–1236

    CAS  PubMed  Google Scholar 

  36. Licker M, Ellenberger C, Sierra J et al (2005) Cardiovascular response to acute normovolemic hemodilution in patients with coronary artery diseases: assessment with transesophageal echocardiography. Crit Care Med 33:591–597

    PubMed  Google Scholar 

  37. Spahn DR, Seifert B, Pasch T, Schmid ER (1998) Haemodilution tolerance in patients with mitral regurgitation. Anaesthesia 53:20–24

    CAS  PubMed  Google Scholar 

  38. Habler O, Meier J, Pape A et al (2007) Tolerance to perioperative anemia. Mechanisms, influencing factors and limits. Urologe A 46:543–558

    PubMed Central  Google Scholar 

  39. Habler OP, Kleen MS, Hutter JW et al (1998) Effects of hyperoxic ventilation on hemodilution-induced changes in anesthetized dogs. Transfusion 38:135–144

    CAS  PubMed  Google Scholar 

  40. Spahn DR, Schmid ER, Seifert B, Pasch T (1996) Hemodilution tolerance in patients with coronary artery disease who are receiving chronic adrenergic blocker therapy. Anesth Analg 82:687–694

    CAS  PubMed  Google Scholar 

  41. Landesberg G, Mosseri M, Wolf Y et al (2002) Perioperative myocardial ischemia and infarction: identification by continuous 12-lead electrocardiogram with online ST-segment monitoring. Anesthesiology 96:264–270

    PubMed  Google Scholar 

  42. Kumar A, Anel R, Bunnell E et al (2004) Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects. Crit Care Med 32:691–699

    PubMed  Google Scholar 

  43. Joyce WP, Provan JL, Ameli FM et al (1990) The role of central haemodynamic monitoring in abdominal aortic surgery. A prospective randomised study. Eur J Vasc Surg 4:633–636

    CAS  PubMed  Google Scholar 

  44. Perz S, Uhlig T, Kohl M et al (2011) Low and „supranormal“ central venous oxygen saturation and markers of tissue hypoxia in cardiac surgery patients: a prospective observational study. Intensive Care Med 37:52–59

    CAS  PubMed  Google Scholar 

  45. Ranucci M, Isgro G, Carlucci C et al (2010) Central venous oxygen saturation and blood lactate levels during cardiopulmonary bypass are associated with outcome after pediatric cardiac surgery. Crit Care 14:R149

    PubMed  PubMed Central  Google Scholar 

  46. Polanczyk CA, Rohde LE, Goldman L et al (2001) Right heart catheterization and cardiac complications in patients undergoing noncardiac surgery: an observational study. JAMA 286:309–314

    CAS  PubMed  Google Scholar 

  47. Sandham JD, Hull RD, Brant RF et al (2003) A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med 348:5–14

    PubMed  Google Scholar 

  48. van Daele M, Sutherland G, Mitchell M et al (1990) Do changes in pulmonary capillary wedge pressure adequately reflect myocardial ischemia during anesthesia? Circulation 81:865–871

    PubMed  Google Scholar 

  49. London MJ, Moritz TE, Henderson WG et al (2002) Standard versus fiberoptic pulmonary artery catheterization for cardiac surgery in the department of veterans affairs: a prospective, observational, multicenter analysis. Anesthesiology 96:860–870

    PubMed  Google Scholar 

  50. Frank SM, Fleisher LA, Breslow MJ et al (1997) Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA 277:1127–1134

    CAS  PubMed  Google Scholar 

  51. AWMF 2013. S3 Leitlinie Vermeidung von perioperativer Hypothermie 2014. Interdisziplinäre Leitlinie der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin, der Deutschen Gesellschaft für Chirurgie, der Deutschen Gesellschaft für Kinderchirurgie, der Österreichischen Gesellschaft für Anästhesie, Reanimation und Intensivmedizin und der Deutschen Gesellschaft für Fachkrankenpflege und

    Google Scholar 

  52. Blomberg S, Emanuelsson H, Freedman B et al (1990) Effects of thoracic epidural anesthesia on coronary arteries and arterioles in patients with coronary artery disease. Anesthesiology 73:840–847

    CAS  PubMed  Google Scholar 

  53. Nishimori M, Ballantyne JC, Low JH (2006) Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev 3:CD005059

    Google Scholar 

  54. Norris EJ, Beattie C, Perler BA et al (2001) Double-masked randomized trial comparing alternate combinations of intraoperative anesthesia and postoperative analgesia in abdominal aortic surgery. Anesthesiology 95:1054–1067

    CAS  PubMed  Google Scholar 

  55. Park WY, Thompson JS, Lee KK (2001) Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled veterans affairs cooperative study. Ann Surg 234:560–569

    CAS  PubMed  Google Scholar 

  56. Beattie WS, Badner NH, Choi P (2001) Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg 93:853–858

    CAS  PubMed  Google Scholar 

  57. Bode RH, Lewis KP, Zarich SW et al (1996) Cardiac outcome after peripheral vascular surgery – comparison of general and regional anesthesia. Anesthesiology 84:3–13

    PubMed  Google Scholar 

  58. Peyton PJ, Myles PS, Silbert BS et al (2003) Perioperative epidural analgesia and outcome after major abdominal surgery in high-risk patients. Anesth Analg 96:548–554

    PubMed  Google Scholar 

  59. Rigg JRA, Jamrozik K, Myles PS et al (2002) Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet 359:1276–1282

    PubMed  Google Scholar 

  60. Christopherson R, Beattle C, Frank SM et al (1993) Perioperative morbidity in patients randomized to epidural or general anesthesia for lower extremity vascular surgery. Anesthesiology 79:422–434

    CAS  PubMed  Google Scholar 

  61. Tuman KJ, McCarthy RJ, March RJ et al (1991) Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesth Analg 73:696–704

    CAS  PubMed  Google Scholar 

  62. Neill F, Sear JW, French G et al (2000) Increases in serum concentrations of cardiac proteins and the prediction of early postoperative cardiovascular complications in noncardiac surgery patients. Anaesthesia 55:641–647

    CAS  PubMed  Google Scholar 

  63. Mauermann WJ, Shilling AM, Zuo Z (2006) A comparison of neuraxial block versus general anesthesia for elective total hip replacement: a meta-analysis. Anesth Analg 103:1018–1025

    PubMed  Google Scholar 

  64. Schug S, Rigg J, Myles P et al (2005) The extended Rodgers study: what do we expect? J Anästh Intensivbehandlung 123–124

    Google Scholar 

  65. Browner WS, Li J, Mangano DT (1992) In-hospital and long-term mortality in male veterans following noncardiac surgery. The study of perioperative ischemia research group. JAMA 268:228–232

    CAS  PubMed  Google Scholar 

  66. Rolf N, Van d Velde M, Wouters PF et al (1996) Thoracic epidural anesthesia improves functional recovery from myocardial stunning in conscious dogs. Anesth Analg 83:935–940

    CAS  PubMed  Google Scholar 

  67. Loick HM, Schmidt C, van Aken H et al (1999) High thoracic epidural anesthesia, but not clonidine, attenuates the perioperative stress response via sympatholysis and reduces the release of troponin T in patients undergoing coronary artery bypass grafting. Anesth Analg 88:701–709

    CAS  PubMed  Google Scholar 

  68. Liu S, Carpenter RL, Neal JM (1995) Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology 82:1474–1506

    CAS  PubMed  Google Scholar 

  69. Manion SC, Brennan TJ (2011) Thoracic epidural analgesia and acute pain management. Anesthesiology 115:181–188

    PubMed  Google Scholar 

  70. Baron JF, Bertrand M, Barré E et al (1991) Combined epidural and general anesthesia versus general anesthesia for abdominal aortic surgery. Anesthesiology 75:611–618

    CAS  PubMed  Google Scholar 

  71. Laxenaire MC, Mertes PM, Groupe d‘etudes des reactions anaphylactoides peranesthesiques (2001) Anaphylaxis during anaesthesia. Results of a two-year survey in France. Br J Anaesth 87:549–558

    CAS  PubMed  Google Scholar 

  72. Gal J, Bogar L, Acsady G, Kertai MD (2006) Cardiac risk reduction in non-cardiac surgery: the role of anaesthesia and monitoring techniques. Eur J Anaesthesiol 23:641–648

    CAS  PubMed  Google Scholar 

  73. De Hert SG, ten Broecke PW, Mertens E et al (2002) Sevoflurane but not propofol preserves myocardial function in coronary surgery patients. Anesthesiology 97:42–49

    PubMed  Google Scholar 

  74. Symons JA, Myles PS (2006) Myocardial protection with volatile anaesthetic agents during coronary artery bypass surgery: a meta-analysis. Br J Anaesth 97:127–136

    CAS  PubMed  Google Scholar 

  75. De HS, Vlasselaers D, Barbe R et al (2009) A comparison of volatile and non volatile agents for cardioprotection during on-pump coronary surgery. Anaesthesia 64:953–960

    Google Scholar 

  76. Badner NH, Beattie WS, Freeman D, Spence JD (2000) Nitrous oxide-induced increased homocysteine concentrations are associated with increased postoperative myocardial ischemia in patients undergoing carotid endarterectomy. Anesth Analg 91:1073–1079

    CAS  PubMed  Google Scholar 

  77. Sobol BJ, Wanlass SA et al (1962) Alteration of coronary blood flow in the dog by inhalation of 100 per cent oxygen. Circ Res 11:797–801

    CAS  PubMed  Google Scholar 

  78. Ganz W, Donoso R et al (1972) Coronary hemodynamics and myocardial oxygen metabolism during oxygen breathing in patients with and without coronary artery disease. Circulation 45:763–768

    CAS  PubMed  Google Scholar 

  79. Nolan JP, Soar J, Zideman DA et al (2010) European resuscitation council guidelines for resuscitation 2010 section 1. Executive summary. Resuscitation 81:1219–1276

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinikum der Universität München, Klinik für Anästhesiologie, Marchioninistr. 15, 81377, München, Deutschland

    Bernhard Zwißler

  2. Klinikum der Universität München, Innenstadt – Großhadern, Klinik für Anästhesiologie der LMU München, Marchioninistr. 15, 81377, München, Deutschland

    Kim Alexander Boost

Authors
  1. Bernhard Zwißler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kim Alexander Boost
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bernhard Zwißler .

Editor information

Editors and Affiliations

  1. Klinik für Anästhesiologie, Universitätsklinikum Aachen RWTH Aachen, Aachen, Deutschland

    Rolf Rossaint

  2. Universitätsklinikum Mainz Klinik für Anästhesiologie, Mainz, Deutschland

    Christian Werner

  3. Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum München Klinikum Großhadern, München, Deutschland

    Bernhard Zwißler

Section Editor information

  1. Klinikum der Universität München, Klinik für Anästhesiologie, Marchioninistr. 15, 81377, München, Germany

    Bernhard Zwißler

Rights and permissions

Reprints and permissions

Copyright information

© 2017 © Springer-Verlag GmbH Deutschland

About this entry

Cite this entry

Zwißler, B., Boost, K.A. (2017). Anästhesie bei Patienten mit Erkrankungen von Herz und Kreislauf: Allgemeine Prinzipien. In: Rossaint, R., Werner, C., Zwißler, B. (eds) Die Anästhesiologie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45539-5_87-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-45539-5_87-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-45539-5

  • Online ISBN: 978-3-662-45539-5

  • eBook Packages: Springer Referenz Medizin

Publish with us

Policies and ethics

Search

Navigation