Sellmann T, Winterhalter M, Herold U, Kienbaum P
Klinik für Anästhesiologie, Universitätsklinikum, Heinrich-Heine Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland.
Anaesthesist. 2010 Jun;59(6):507-18. doi: 10.1007/s00101-010-1737-3.
Updated cardiologic guidelines constitute the background for an extended spectrum of indications for the implantation of automatic implantable cardioverter defibrillators (AICDs) and lead to an increasing number of operative implantations of AICDs. Moreover, during implantation of devices for cardiac resynchronization therapy the anesthesiologist is responsible for the most critically ill patients with the longest duration of surgery. As a result anesthesiologists face an increasing number of critically ill patients, whose management contributes to perioperative outcome. Automatic implantable cardioverter defibrillators can be implanted either during general anesthesia, local anesthesia or during a combination of local anesthesia combined with deep conscious sedation accomplished by an anesthesiologist. Besides economic aspects there is an increasing demand for anesthesia with the least cardiovascular side effects and rapid recovery in the often seriously ill patient with preexisting limitations of cardiac and pulmonary functions. Accordingly procedure and anesthesia-associated risks are reviewed and an algorithm for anesthesia management is suggested.
更新后的心脏病学指南构成了扩大自动植入式心脏复律除颤器（AICD）植入适应症范围的背景，并导致AICD手术植入数量的增加。此外，在心脏再同步治疗设备植入过程中，麻醉医生负责治疗病情最危重、手术时间最长的患者。因此，麻醉医生面临着越来越多的危重患者，对这些患者的管理有助于围手术期的结果。自动植入式心脏复律除颤器可以在全身麻醉、局部麻醉或由麻醉医生实施的局部麻醉联合深度镇静的情况下植入。除了经济方面，对于那些心脏和肺功能已有限制的重病患者，对具有最小心血管副作用和快速恢复的麻醉的需求也在增加。因此，对手术和麻醉相关风险进行了回顾，并提出了麻醉管理算法。
