Publikationsserver der RWTH Aachen University
Intraoperative Kaudalanästhesie bei Kindern mit hereditären neuromuskulären Erkrankungen : Benefit oder unnötige Risikoerhöhung?
Abstract
dc:descriptionHereditary neuromuscular diseases occurring in childhood and adolescence cause an exceptional burden for the affected patients and their families. These are associated with massive limitations and particularly in Duchenne Muscular Dystrophy with increasing disability and a decrease in life expectancy. Therapies that maintain the ability to move are of particular importance for quality of life and for preventing complications such as pulmonary infections. Physiotherapy is not sufficiently qualified for preventing muscular contractures, which develop based on a deficiency of movement. As a rule finally operations are required to prolong the ability to walk or stand. Accompanying hereditary neuromuscular diseases is a genetic disposition for Malignant Hyperthermia which is caused by a modified physiology of the muscle cells. To avoid life-threatening complications these special risks have to be considered in anaesthesia. For example certain trigger substances like depolarising muscle relaxants (e.g. succinylcholine) and volatile inhalation narcotics are contraindicated. The evaluated patients received either balanced anaesthesia or total intravenous anaesthesia (TIVA) and partially additional peridural anaesthesia whenever surgical procedure and anatomical situations allowed. The observed decrease in the use of analgesics during operations in patients that had received peridural anaesthesia had to be proven by a statistical analysis. This is a study in retrospect. Only those cases with largely completed data have been evaluated. A possible dependence between the need of analgesics and regional anaesthesia, gender, application of nitrous oxide, kind of disease and kind of surgical procedure was analyzed. Furthermore the corresponding effect was examined at the time of surgery as well as postoperatively during the sojourn in the intensive care unit and on the ward. For those cases with additive peridural anaesthesia a significant (P 0.000 – 0.026) decrease in the consumption of opioids as well as non-opioid analgesics was found in comparison to the reference group without regional anaesthesia. This was valid for the time during surgery and intensive care. For the remaining parameters (e.g. gender) minimal to no influence was noticed. Although the surgical procedure results in an important improvement of quality of life for the patients, initially it means additional physical as well as psychological stress. Assuming a comparable state of consciousness between the two groups, the patients with peridural anaesthesia perceived a reduced or delayed onset of pain, leading to the statistically proven decrease in consumption of analgesics. This as well as a decreased risk of side effects of analgesics such as nausea are great benefits. Therefore a combination of general anaesthesia and regional anaesthesia should be implemented especially in patients suffering from hereditary neuromuscular diseases whenever surgical procedure and anatomical situations allow. However the superiority of this method has to be proven by prospective studies.
Degree
thesis:*- Grantor dc:publisher
- Publikationsserver der RWTH Aachen University
- Year dc:date
- 2009
Author and committee
dc:creator, dc:contributor.*- Author dc:creator
-
- Grüdl, Tanja
- Contributors dc:contributor
-
- Rossaint, Rolf
Subjects
dc:subject × 8Rights
dc:rights- Statement dc:rights
-
- info:eu-repo/semantics/openAccess
- Language dc:language
- ger