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[术中手术及麻醉问题及其对手术的影响]

[Intraoperative surgical and anesthesiological problems and the consequences for surgery].

作者信息

Beckmann J, Bein B, Steinfath M, Becker T

机构信息

Klinik für Allgemeine Chirurgie und Thoraxchirurgie, Universitätsklinikum Schleswig Holstein, Campus Kiel, Arnold Heller Str. 3, 24105, Kiel, Deutschland.

出版信息

Chirurg. 2012 Jul;83(7):617-25. doi: 10.1007/s00104-011-2213-6.

Abstract

Although the procedures for severe intraoperative complications have largely been defined, in everyday life less dramatic but equally important problems and issues arise which are controversially debated between treating surgeons and the anesthesiologists. Preoperative anemia, transfusion therapy, fluid management, patient positioning, hypothermia and neuromuscular blockade are the focus of the occasionally conflicting interests of anesthesiologists and surgeons. Good reciprocal communication and mutual understanding are a requirement for proactive management of complications. The overall objective is the reduction of intraoperative risks thereby reducing morbidity and mortality. This can be achieved through modern fluid management, blood conserving techniques and maintenance of normothermia. Surgeons further require an optimal view during minimally invasive surgery even by complex patient positioning and adequate neuromuscular blockade.

摘要

虽然严重术中并发症的处理流程在很大程度上已明确,但在日常工作中,会出现一些不那么严重但同样重要的问题,这些问题在外科医生和麻醉医生之间存在争议。术前贫血、输血治疗、液体管理、患者体位、体温过低和神经肌肉阻滞是麻醉医生和外科医生偶尔存在利益冲突的焦点。良好的相互沟通和相互理解是积极处理并发症的必要条件。总体目标是降低术中风险,从而降低发病率和死亡率。这可以通过现代液体管理、血液保护技术和维持正常体温来实现。外科医生在微创手术中还需要通过复杂的患者体位和适当的神经肌肉阻滞获得最佳视野。

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