Standl T
Klinik für Anästhesie, Operative Intensiv- u. Palliativmedizin, Städtisches Klinikum Solingen gGmbH, Gotenstraße 1, 42653, Solingen, Deutschland.
Med Klin Intensivmed Notfmed. 2017 Mar;112(2):111-116. doi: 10.1007/s00063-016-0247-8. Epub 2017 Jan 10.
Cardiovascular comorbidities in surgical patients are frequent and have a substantial impact on the postoperative outcome. Neuraxial blockades are able to reduce perioperative morbidity and mortality. The increasing use of new oral anticoagulants (NOAC) requires a high level of attention, especially in patients undergoing neuraxial blockades or requiring postoperative analgesia.
The goal of this article is to present the benefit of neuraxial anaesthesia and analgesia in patients with cardiovascular risks and perioperative management of NOAC in this setting.
Review of the respective literature in PubMed during the last 25 years as well as presentation of the S1 guideline "Neuraxial anaesthesia and thrombo-embolic prophylaxis/antithrombotic medication" of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI).
Thoracic epidural anaesthesia and analgesia contribute to an improved outcome in surgical patients with high cardiovascular risk. In order to avoid severe complications in patients on NOACs undergoing neuraxial blockades the S1 guideline of the DGAI must be respected and close interdisciplinary consultations between anaesthetist, cardiologist and surgeon are mandatory.
In consideration of the respective guideline neuraxial blockades can be performed in cardiovascular risk patients on NOACs, since these techniques contribute to an improved postoperative outcome.
手术患者心血管合并症很常见，对术后结局有重大影响。神经轴阻滞能够降低围手术期发病率和死亡率。新型口服抗凝药（NOAC）的使用日益增加，这需要高度关注，尤其是在接受神经轴阻滞或需要术后镇痛的患者中。
本文的目的是介绍在有心血管风险的患者中神经轴麻醉和镇痛的益处以及在此情况下NOAC的围手术期管理。
回顾过去25年PubMed上的相关文献，并介绍德国麻醉学和重症医学学会（DGAI）的S1指南“神经轴麻醉与血栓栓塞预防/抗血栓药物”。
胸段硬膜外麻醉和镇痛有助于改善心血管风险高的手术患者的结局。为避免接受神经轴阻滞的NOAC患者出现严重并发症，必须遵循DGAI的S1指南，麻醉医生、心脏病专家和外科医生之间进行密切的多学科会诊是必要的。
考虑到相关指南，在服用NOAC的心血管风险患者中可以进行神经轴阻滞，因为这些技术有助于改善术后结局。
