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Balancierte Anästhesie

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Pharmakotherapie in der Anästhesie und Intensivmedizin

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Zusammenfassung

» Eine Allgemeinanästhesie, die durch eine Kombination verschiedener Anästhetika mit synergistischen pharmakologischen Eigenschaften aufrechterhalten wird, bezeichnet man als balancierte Anästhesie. «

Mononästhesien, d. h. Anästhesien unter Verwendt von nur einem Anästhetikum, werden heute praktinicht mehr durchgeführt. Eine Allgemeinanästhesie wird heute meist aus einer Kombination von mindestens 2.oder mehr Anästhetika aufrechterhalten [41]. Eine Inhalaticanästhesie wird ausschließlich als eine Kombinationsästhesie aus Lachgas (Stickoxydul, N2O), Sauerstoffieinem Inhalationsanästhetikum durchgeführt [5][9][12][ [45][49]. Auch bei einer totalen intravenösen Anästhesie (TIVA) wird ein Hypnotikum (Propofol) mit einem Analge-tikum (z. B. Remifentanil) kombiniert [10]. In der balancierten Anästhesie werden Inhalationsanästhetika mit i.v.-An-ästhetika kombiniert [40].

Heute wird mit dem Begriffder balancierten Anästhesie meistens eine Kombination aus intravenöser Opioidgäbe (Analgesie) und Inhalationsanästhesie (Hypnose) verbunden [47]. Der Begriffist jedoch wie oben bereits erwähnt nicht eng definiert und wurde auch schon für andere Kombinationen von Anästhetika wie z. B. Regionalan-algesie und Inhalationsanästhesie verwendet [44].

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Literatur

  1. Alghanem SM, Massad IM, Rashed EM, Abu-AIi HM, Daradkeh SS (2009) Optimization of anesthesia antiemetic measures versus combination therapy using dexamethasone or ondansetron for the prevention of postoperative nausea and vomiting. Surg Endosc

    Google Scholar 

  2. Alwardt CM, Redford D, Larson DF (2005) General anesthesia in cardiac surgery: a review of drugs and practices. J Extra Corpor Technol 37:227–235

    PubMed  Google Scholar 

  3. Baum JA (1990) Clinical applications of low flow and closed circuit anesthesia. Acta Anaesthesiol Belg 41:239–247

    PubMed  CAS  Google Scholar 

  4. Baum JA (1995) [John Snow (1813–1858): experimental studies on rebreathing of anesthetic gases in exhaled air]. Anasthesiol Intensivmed Notfallmed Schmerzther 30:37–41

    Article  PubMed  CAS  Google Scholar 

  5. Baum JA (1997) Low-flow anaesthesia: the sensible and judicious use of inhalation anaesthetics. Acta Anaesthesiol Scand Suppl 111:S264–267

    Google Scholar 

  6. Baum JA (1998) Die Inhalationsnarkose mit niedrigem Frischgasfluß. Thieme, Stuttgart New York

    Google Scholar 

  7. Baum JA (2004) The carrier gas in anaesthesia: nitrous oxide/ oxygen, medical air/oxygen and pure oxygen. Curr Opin Anaesthesiol 17:513–516

    Article  PubMed  Google Scholar 

  8. Baum JA (2005) New and alternative delivery concepts and techniques. Best Pract Res Clin Anaesthesiol 19:415–428

    Article  PubMed  Google Scholar 

  9. Baum JA, Sievert B, Stanke HG, Brauer K, Sachs G (2000) [Nitrous oxide free low-flow anesthesia]. Anaesthesiol Reanim 25:60–67

    PubMed  CAS  Google Scholar 

  10. Brady WJ, Meenan DR, ShankarTR, Balon JA, Mennett DR (2005) Use of a remifentanil and propofol combination in outpatients to facilitate rapid discharge home. AANA J 73:207–210

    PubMed  Google Scholar 

  11. Brody S (1945) Bioenergetics and Growth. Reinhold, New York

    Google Scholar 

  12. Cheeley LN (1956) Nitrous oxide, trichlorethylene, and ether; a balanced anesthesia in obstetrics. Curr Res Anesth Analg 35: 422–424

    PubMed  CAS  Google Scholar 

  13. Cheney FW (2007) An early example of evidence-based medicine: hypoxemia due to nitrous oxide. Anesthesiology 106: 186–188

    Article  PubMed  Google Scholar 

  14. Coppens MJ, Versichelen LF, Roily G, Mortier EP, Struys MM (2006) The mechanisms of carbon monoxide production by inhalational agents. Anaesthesia 61:462–468

    Article  PubMed  CAS  Google Scholar 

  15. da Silva JM, Mapleson WW, Vickers MD (1997) Quantitative study of Lowe's square-root-of-time method of closed-system anaesthesia. Br J Anaesth 79:103–112

    Article  PubMed  CAS  Google Scholar 

  16. Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (2008) Empfehlung zur Therapie der malignen Hyperthermie. Anästh Intensivmed 49:483–488

    Google Scholar 

  17. Eger E, Eisenkraft J, Weiskopf R (2003) History of modern inhaled anesthetics. The Pharmacology of inhaled anesthetics. Library of Congress number:TXVI-035635, San Francisco

    Google Scholar 

  18. Eger EI, lonescu P, Laster MJ, Weiskopf RB (1997) Baralyme dehydration increases and soda lime dehydration decreases the concentration of compound A resulting from sevoflurane degradation in a standard anesthetic circuit. Anesth Analg 85: 892–898

    PubMed  CAS  Google Scholar 

  19. Fang ZX, Eger El (1995) Factors affecting the concentration of compound A resulting from the degradation of sevoflurane by soda lime and Baralyme in a standard anesthetic circuit. Anesth Analg 81:564–568

    PubMed  CAS  Google Scholar 

  20. Fang ZX, Eger EI, Laster MJ et al. (1995) Carbon monoxide production from degradation of desflurane, enflurane, isoflurane, halothane, and sevoflurane by soda lime and Baralyme. Anesth Analg 80:1187–1193

    PubMed  CAS  Google Scholar 

  21. Fang ZX, Kandel L, Laster MJ, lonescu P, Eger El (1996) Factors affecting production of compound A from the interaction of sevoflurane with Baralyme and soda lime. Anesth Analg 82: 775–781

    PubMed  CAS  Google Scholar 

  22. Fleming P, Walker PO, Priest JR (1988) Bleomycin therapy: a contraindication to the use of nitrous oxide-oxygen psychosedation in the dental office. Pediatr Dent 10:345–346

    PubMed  CAS  Google Scholar 

  23. Funk W, Gruber M, Wild K, Hobbhahn J (1999) Dry soda lime markedly degrades sevoflurane during simulated inhalation induction. Br J Anaesth 82:193–198

    Article  PubMed  CAS  Google Scholar 

  24. Gabrielsen J, Valentin N (1982) Routine induction of anaesthesia with thiopental and suxamethonium: apnoea without ventilation? Acta Anaesthesiol Scand 26:59–62

    Article  PubMed  CAS  Google Scholar 

  25. Gan TJ (2006) Risk factors for postoperative nausea and vomiting. Anesth Analg 102:1884–1898

    Article  PubMed  Google Scholar 

  26. Härtung E, Anetseder M, Olthoff D et al. (1998) [Regional distribution of predisposition to maligant hyperthermia in Germany: täte in 1997]. Anasthesiol Intensivmed Notfallmed Schmerzther 33:238–242

    Article  PubMed  Google Scholar 

  27. Herff H, Paal P, Lindner KH et al. (2008) [Fatalities due to nitrous oxide. Complications from mistakes in nitrous oxide supply]. Anaesthesist 57:1006–1010

    Article  PubMed  CAS  Google Scholar 

  28. Herff H, Paal P, Lindner KH, Keller C, Wenzel V (2007) Fatal errors in nitrous oxide delivery. Anaesthesia 62:1202–1206

    Article  PubMed  CAS  Google Scholar 

  29. Hoenemann CW, Halene-HoltgraeveTB, Booke M et al. (2003) Delayed onset of malignant hyperthermia in desflurane anesthesia. Anesth Analg 96:165–167

    PubMed  Google Scholar 

  30. Honemann CW, Hahnenkamp K, Mollhoff T, Baum JA (2001) Minimal-flow anaesthesia with controlled ventilation: comparison between laryngeal mask airway and endotracheal tube. Eur J Anaesthesiol 18:458–466

    PubMed  CAS  Google Scholar 

  31. Horn EP (2002) [Reduction by half of wound infection rate after colon surgery through increase of inspirational oxygen concentration from 30% to 80%]. Anasthesiol Intensivmed Notfallmed Schmerzther 37:56–57

    Article  PubMed  CAS  Google Scholar 

  32. Jurkat-Rott K, McCarthy T, Lehmann-Horn F (2000) Genetics and pathogenesis of malignant hyperthermia. Muscle Nerve 23:4–17

    Article  PubMed  CAS  Google Scholar 

  33. Kleemann PP (1990) The climatisation of anesthetic gases under conditions of high flow to low flow. Acta Anaesthesiol Belg 41: 189–200

    PubMed  CAS  Google Scholar 

  34. Kleemann PP (1994) Humidity of anaesthetic gases with respect to low flow anaesthesia. Anaesth Intensive Care 22:396–408

    PubMed  CAS  Google Scholar 

  35. Kleemann PP (1995) [Improved climatization of anesthetic gases by modifying the Sulla 808 V anesthesia equipment]. Anaesthesiol Reanim 20:71–75

    PubMed  CAS  Google Scholar 

  36. Neumann MA, Laster MJ, Weiskopf RB et al. (1999) The elimination of sodium and potassium hydroxides from desiccated soda lime diminishes degradation of desflurane to carbon monoxide and sevoflurane to compound A but does not compromise carbon dioxide absorption. Anesth Analg 89:768–773

    PubMed  CAS  Google Scholar 

  37. Norris MC, Dewan DM (1985) Preoxygenation for cesarean section: a comparison of two techniques. Anesthesiology 62: 827–829

    Article  PubMed  CAS  Google Scholar 

  38. Nost R, Thiel-Ritter A, Scholz S, Hempelmann G, Muller M (2008) Balanced anesthesia with remifentanil and desflurane: clinical considerations for dose adjustment in adults. J Opioid Manag 4: 305–309

    PubMed  Google Scholar 

  39. Oczenski W, Schwarz S, Fitzgerald RD (2004) Vital capacity manoeuvre in general anaesthesia: useful or useless? Eur J Anaesthesiol 21:253–259

    PubMed  CAS  Google Scholar 

  40. Punjasawadwong Y, Boonjeungmonkol N, Phongchiewboon A (2007) Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev CD003843

    Google Scholar 

  41. Quadan M, Akca O, Mahid SS, Hornung CA, Polk HC (2009) Perioperative supplemental oxygen therapy and surgical site infekction: a meta-analysis of randomized controlled trials. Arch Surg 144:359–366

    Article  Google Scholar 

  42. Reinoso-Barbero F, Martinez-Garcia E, Hernandez-Gancedo MC, Simon AM (2006) The effect of epidural bupivacaine on maintenance requirements of sevoflurane evaluated by bispectral index in children. Eur J Anaesthesiol 23:460–464

    Article  PubMed  CAS  Google Scholar 

  43. Rosenberg H, Davis M, James D, Pollock N, Stowell K (2007) Malignant hyperthermia. Orphanet J Rare Dis 2:21

    Article  PubMed  Google Scholar 

  44. Shane SM, Ashman H (1952) A clinical study of a balanced anesthesia mixture; report of 10,000 cases. South Med J 45:591–595

    Article  PubMed  CAS  Google Scholar 

  45. Shanks CA, Fragen RJ, Ling D (1993) Continuous intravenous infusion of rocuronium (ORG 9426) in patients receiving balanced, enflurane, or isoflurane anesthesia. Anesthesiology 78:649–651

    Article  PubMed  CAS  Google Scholar 

  46. Steffey EP, Laster MJ, lonescu P (1997) Dehydration of Baralyme increases compound A resulting from sevoflurane degradation in a standard anesthetic circuit used to anesthetize swine. Anesth Analg 85:1382–1386

    PubMed  CAS  Google Scholar 

  47. Tonner PH (2005) Balanced anaesthesia today. Best Pract Res Clin Anaesthesiol 19:475–484

    Article  PubMed  CAS  Google Scholar 

  48. Tziavrangos E, Schug SA (2006) Regional anaesthesia and peri-operative outcome. Curr Opin Anaesthesiol 19:521–525

    Article  PubMed  Google Scholar 

  49. Van AH, Van HJ, Merckx L, Mollhoff T, Mulier J, Lubbesmeyer HJ (1990) [Total intravenous anesthesia using propofol and alfentanil in comparison with balanced anesthesia in neurosurgery]. Anasth Intensivther Notfallmed 25:54–58

    Article  Google Scholar 

  50. Waters RM (1924) Clinical Scope and Utility of Carbon Dioxid Filtration in Inhalation Anaesthesia. Anesth Analg 1924:20–22

    Google Scholar 

  51. Waterson CK (1984) Recovery of waste anesthetic gases. In: Brown BR (ed.) Future Anesthesia Delivery Sytems. Contemporary Anesthesia Practice, Vol. VIII. Davis, Philadelphia

    Google Scholar 

  52. Wyatt SS, Gill RS (1999) An absolute contraindication to nitrous oxide. Anaesthesia 54:307

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Klinik für Anästhesie u. operative Intensivmedizin, St.-Marienhospital Vechta, Vechta, Marienstr. 6-8, 49377, Germany

    Dr. Christian Hönemann

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  1. Dr. Christian Hönemann
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Editors and Affiliations

  1. Klinik für Anästhesie, operative und allg. Intensivmedizin, Notfallmedizin, Klinikum Links der Weser gGmbH, Senator-Weßling-Str. 1, 28277, Bremen

    Peter H. Tonner

  2. Klinik für Anästhesie und Intensivmedizin, Klinikum Bremen Nord gGmbH, Hammersbecker Str. 228, 28755, Bremen

    Peter H. Tonner

  3. Institut für Exp. u. Klin. Pharmakologie u. Toxikologie - Abt. II, Universität Freiburg, Albertstraße 25, 79104, Freiburg

    Lutz Hein

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Hönemann, C. (2011). Balancierte Anästhesie. In: Tonner, P.H., Hein, L. (eds) Pharmakotherapie in der Anästhesie und Intensivmedizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-79156-0_15

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  • DOI: https://doi.org/10.1007/978-3-540-79156-0_15

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