Zusammenfassung
Die verbesserte medikamentöse Therapie in der Urologie führt zu immer älteren Patienten mit entsprechender Komorbidität im OP. Gleichzeitig bieten sich neue operative Möglichkeiten durch verbesserte technische Geräte. Die Operationspositionen wie Bauchlage und Steinschnittlage führen zu physiologischen Änderungen, die die Anästhesieführung beeinflussen. Das Risiko von Eingriffen wie transurethrale Prostata- oder Blasenresektion ist durch aufkommende Neuerungen (z. B. Lasertechnik) verändert worden. Die Inzidenz des Transurethrale-Resektion(TUR)-Syndroms hat sich zwischenzeitlich verringert, dennoch muss auch heute an eine Einschwemmung von Spülflüssigkeit gedacht werden. Die roboterassistierte Chirurgie hat das Experimentierstadium bereits überwunden und findet zunehmend breiten Einsatz, sodass auf die neuen Anforderungen eingegangen werden muss. Die Ureterorenoskopie wird mittlerweile unter dem Einsatz flexibler, schmallumiger Endoskope immer häufiger erfolgreich auch bei Nierenbeckensteinen durchgeführt und kann in Analgosedation mit sehr kurzen Anästhesiezeiten vorgenommen werden. Bei der perkutanen Nephrostomie und Litholapaxie befindet sich der Patient häufig in Bauchlage. Im Hinblick auf die Risiken, die sich aus der Positionierung ergeben, sollte aber individuell die Durchführung in Rücken- oder Seitenlage erwogen werden. Eine gute präoperative Kommunikation zwischen Operateur und Anästhesist kann bei speziellen Indikationen ein Abweichen vom „Hausstandard“ ermöglichen. Fundierte Kenntnisse in der (Patho-)Physiologie der allgemeinen Anästhesie, erweitert um Kenntnisse der speziellen Krankheitsbilder der endourologischen Eingriffe, bilden die Grundlagen einer vorausschauenden Anästhesie, die das Auftreten von lebensbedrohlichen Zwischenfällen verhindern soll.
Abstract
The improved drug therapy leads to increasingly older patients with complex comorbidities in the discipline of operative urology. Today, improved technical equipment provides new operational capabilities in the field of urology. The prone and lithotomy position during surgery leads to physiological changes that affect anesthesia management. The surgical risk of procedures such as transurethral surgery of the prostate or bladder is being altered by laser surgery and other new technologies. Although the incidence of transurethral resection (TUR) syndrome has been reduced in recent years, the intrusion of irrigation fluid still has to be considered during anesthesia. Robot-assisted surgery has successfully completed the experimental stage and is widely used so that new targets have to be challenged. Ureterorenoscopy is performed with flexible, small caliber ureteroscopes which even allow treatment of renal calculi under analgosedation within short time periods. Percutaneous nephrostomy and litholapaxy are still frequently performed in the prone position. With respect to the risks arising from patient positioning, supine or lateral positioning should be considered in individual cases. A good communication between the surgeon and anesthetist allows deviation from daily routine procedures if special indications require a modified approach. In conclusion, a profound knowledge of the (patho-)physiology of general anesthesia and endourological diseases enables anesthetists to provide a prospective type anesthesia, which should prevent the occurrence of life-threatening incidents.
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Kiss, T., Bluth, T. & Heller, A. Anästhesie bei endourologischen und roboterassistierten Eingriffen. Anaesthesist 61, 733–747 (2012). https://doi.org/10.1007/s00101-012-2047-8
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DOI: https://doi.org/10.1007/s00101-012-2047-8