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Regionalanästhesie und neurologische Erkrankungen

Regional anesthesia and neurological diseases

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Zusammenfassung

Immer häufiger wird der klinisch tätige Anästhesist mit Patienten konfrontiert, die an einer neurologischen Erkrankung leiden und einer operativen Intervention zugeführt werden müssen. Verbesserte Diagnostik und Therapie dieser Erkrankungen ließen v. a. im Bereich der Geburtshilfe die Zahl schwangerer Patientinnen mit solchen Grunderkrankungen deutlich ansteigen. Aber nicht nur in der Geburtshilfe, sondern auch bei anderen Patienten mit neurologischen Erkrankungen könnten Verfahren der Regionalanästhesie vorteilhaft sein. Andererseits gilt es zu bedenken, das gerade bei diesen Verfahren die verwendeten Medikamente und auch die benutzen Techniken direkte Effekte an den Neuronen zeigen und damit potenziell den Krankheitsverlauf beeinflussen. Folglich muss die Indikation für ein Regionalanästhesieverfahren bei diesen Patienten immer einer sorgfältiger Risiko-Nutzen-Abwägung unterzogen werden. Zusätzlich ist zu bedenken, dass die Durchführung möglicherweise komplizierter ist und das Blockadeergebnis von dem erwarteten abweichen kann. Da bislang nur wenige systematische Untersuchungen zu diesem Thema vorliegen, muss v. a. auf Fallberichte zurückgegriffen werden. Die vorliegende Übersicht diskutiert zunächst auf der Basis der verfügbaren wissenschaftlichen Evidenz allgemeine Überlegungen zu Auswahl und Durchführung von Regionalverfahren bei Patienten mit neurologischen Erkrankungen. Im zweiten Teil werden exemplarisch einige klinisch relevante neurologische Krankheitsbilder im Zusammenhang mit der praktischen Durchführung der Regionalanästhesie erörtert.

Abstract

Modern anesthesia is handling an increasing number of patients with neurological diseases who require narcosis. Regional anesthesia techniques offer qualities which might be advantageous for this group particularly for childbirth. The number of pregnant women with neurological diseases has increased significantly in the recent years due to improved diagnostics and therapy. A more careful approach to regional anesthesia in patients with neurological diseases is necessary as the drugs themselves possess neurotoxic effects and the procedure might worsen the underlying neurological diseases. Additionally, performing regional anesthesia might be more complicated and the resulting blockade might be different from the expected neuronal block. Published data concerning regional anesthesia in this patient group are limited and mainly restricted to case reports. In this review general considerations regarding regional anesthesia, techniques, drugs and methods in these patient groups will be discussed. In the second part the practical approach to regional anesthesia for some of the most important neurological diseases is highlighted.

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  1. Klinik für Anästhesiologie, Universität Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Deutschland

    B. Sinner D.E.A.A. & B.M. Graf

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  1. B. Sinner D.E.A.A.
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  2. B.M. Graf
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Correspondence to B. Sinner D.E.A.A..

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Anhang

Tab. 2 Zusammenstellung der wichtigsten Fallberichte zur Durchführung von Regionalverfahren bei Patienten mit neurologischen Erkrankungen
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Sinner, B., Graf, B. Regionalanästhesie und neurologische Erkrankungen. Anaesthesist 59, 781–805 (2010). https://doi.org/10.1007/s00101-010-1776-9

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