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Langzeitmedikation und perioperatives Management

Perioperative management of long-term medication

  • Arzneimitteltherapie
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Zusammenfassung

Anästhesisten und Operateure sehen sich zunehmend mit Patienten konfrontiert, die unter einer medikamentösen Dauertherapie stehen. Ein Teil dieser Medikamente können mit Anästhetika oder anästhesiologischen und/oder chirurgischen Interventionen interagieren. Als Folge können Komplikationen wie Blutungen, Ischämien, Infektionen oder schwere Kreislaufreaktionen auftreten. Andererseits birgt oft gerade das perioperative Absetzen von Medikamenten die größere Gefahr. Der Anteil ambulant durchgeführter Operationen hat in den letzten Jahren stark zugenommen und wird voraussichtlich auch in Zukunft zunehmen. Seit Einführung der Fallpauschalen (in der Schweiz bevorstehend) wird der Patient in der Regel erst am Vortag der Operation stationär aufgenommen. Somit sind sowohl zuweisende Ärzte als auch Anästhesisten und Operateure gezwungen, sich frühzeitig mit Fragen der perioperativen Pharmakotherapie auseinanderzusetzen. Dieser Übersichtsartikel behandelt das Management der wichtigsten Medikamentenklassen während der perioperativen Phase. Neben kardial und zentral wirksamen Medikamenten und Wirkstoffen, welche auf die Hämostase und das endokrine System wirken, werden Spezialfälle wie Immunsuppressiva und Phytopharmaka behandelt.

Abstract

Anesthesiologists and surgeons are increasingly faced with patients who are under long-term medication. Some of these drugs can interact with anaesthetics or anaesthesia and / or surgical interventions. As a result, patients may experience complications such as bleeding, ischemia, infection or severe circulatory reactions. On the other hand, perioperative discontinuation of medication is often more dangerous. The proportion of outpatient operations has increased dramatically in recent years and will probably continue to increase. Since the implementation of DRGs (pending in Switzerland, introduced in Germany for some time), the patient enters the hospital the day before operation. This means that the referring physician as well as anesthesiologists and surgeons at an early stage must deal with issues of perioperative pharmacotherapy. This review article is about the management of the major drug classes during the perioperative period. In addition to cardiac and centrally acting drugs and drugs that act on hemostasis and the endocrine system, special cases such as immunosuppressants and herbal remedies are mentioned.

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Danksagung

Wir danken Prof. Dr. Stephan Krähenbühl für die kritische Durchsicht des Manuskripts.

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Authors and Affiliations

  1. Spitalapotheke, Kantonsspital Schaffhausen, Schaffhausen, Schweiz

    I. Vogel Kahmann

  2. Departement für Anästhesie und Intensivmedizin, Universitätsspital Basel, Basel, Schweiz

    W. Ruppen & G. Lurati Buse

  3. Hämatologie, Universitätsspital Basel, Basel, Schweiz

    D.A. Tsakiris

  4. Klinische Pharmakologie und Toxikologie, Universitätsspital Basel, Hebelstrasse 2, 4031, Basel, Schweiz

    M. Bruggisser

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  1. I. Vogel Kahmann
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Correspondence to M. Bruggisser.

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Die Autoren Irene Vogel Kahmann und Wilhelm Ruppen haben zu gleichen Teilen zu der Arbeit beigetragen.

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Vogel Kahmann, I., Ruppen, W., Lurati Buse, G. et al. Langzeitmedikation und perioperatives Management. Internist 52, 89–98 (2011). https://doi.org/10.1007/s00108-010-2755-6

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