Elektive Kolonresektionen in Deutschland

Der Anaesthesist (Impact Factor: 0.76). 11/2007; 56(12):1223-1230. DOI: 10.1007/s00101-007-1259-9


HintergrundDie „Fast-Track“-Rehabilitation im Rahmen elektiver Kolonresektionen ist ein multimodales, perioperatives Behandlungskonzept,
das chirurgische und anästhesiologische Aspekte kombiniert. Dadurch wird die Rate allgemeiner Komplikationen vermindert und
eine rasche Rekonvaleszenz ermöglicht. Die hier vorgestellte Umfrage untersucht die Verbreitung und die Anwendung dieses Konzeptes
in Deutschland.

MethodenIm Januar 2006 erhielten 1270 anästhesiologische Abteilungen einen Fragebogen, in dem das übliche anästhesiologische Vorgehen
anhand einer konventionellen Sigmaresektion beschrieben werden sollte.

ErgebnisseDie Rücklaufrate betrug 385 (30,3%). Es wird eine präoperative Nahrungskarenz bezüglich fester Kost von 12h vor dem Eingriff
in 52% und von 6h in 44% der Kliniken eingehalten; bezüglich der Aufnahme von Flüssigkeiten beträgt die Karenzzeit 6h in
47% und 2h 41% in der Kliniken. Eine Prophylaxe gegen postoperative Übelkeit und Erbrechen („postoperative nausea and vomiting“,
PONV) führen 33% der Befragten durch. Propofol (68%) ist das führende Narkotikum. Fentanyl (56%) und Sufentanil (48%) sind
die am weitesten verbreiteten Analgetika. Es nutzen 75% der anästhesiologischen Abteilungen epidurale Analgesien.

SchlussfolgerungIn Deutschland orientiert sich die anästhesiologische Versorgung im Rahmen elektiver Kolonresektionen in weiten Teilen an
den evidenzbasierten Empfehlungen zur „Fast-Track“-Chirurgie.

BackgroundFast-track rehabilitation after elective colon resection is an interdisciplinary multimodal procedure, which combines surgical
and anesthesiological aspects. This leads to an improved and accelerated recovery and avoids perioperative complications.
This survey focuses on the extent and use of such concepts in Germany.

MethodsIn January 2006, a questionnaire was sent to 1270 anesthesiology departments in Germany in which they were asked to describe
the standard anesthesia procedures based on a conventional sigmoid resection.

ResultsThe response rate was 385 out of 1270 (30.3%). Preoperative fasting of solid food 12h before the operation was practiced
in 52% and for 6h in 44% of the clinics. For fluid intake the fasting time was 6h in 47% and 2h in 41%. Prophylactic measures
for postoperative nausea and vomiting (PONV) were administered in 33% of clinics. Propofol (68%) was the leading narcotic,
fentanyl (56%) and sufentanil (48%) were the most commonly used intraoperative analgesics and 75% of clinics used epidural

ConclusionIn Germany the anesthesiological treatment after elective colon surgery adheres broadly to the evidence-based recommendations
for fast-track concepts.

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