Patientensicherheit in der Anästhesie – Kann der Anästhesist das Outcome verbessern?

 

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Zusammenfassung

Grundsätzlich sind wir uns im Klaren darüber, dass trotz fachspezifischer pharmakologischer und technologischer Innovationen in unserem Fachgebiet auch heute noch perioperativ Änderungen im physiologischen Gleichgewicht induziert werden, die durchaus zu einer Erhöhung postoperativer Komplikationen und konsequenterweise auch zu einer Erhöhung der Mortalität führen können. Die unmittelbar Anästhesie-bedingte Mortalität konnte in den letzten Jahrzehnten signifikant gesenkt werden und liegt derzeit bei ca. 0,055 pro 10 000 Anästhesien. Anders sieht das mit der Anästhesie-assoziierten Mortalität aus. Hier sind die Daten uneinheitlich und die Vergleichbarkeit der verschiedenen, meist retrospektiven Analysen problematisch. Erfreulicherweise hat der Aspekt „Patientensicherheit in der Anästhesie“ in den letzten Jahren enorm an Aufmerksamkeit gewonnen und zeigt eine zunehmende mediale Präsenz. So gibt es heute sehr vielversprechende Initiativen, die sich mit dieser Thematik intensiv befassen. Für die Zukunft wäre es wünschenswert, den Fokus über den unmittelbaren intraoperativen Bereich hinaus zu erweitern und zumindest bei Risikopatienten auf den gesamten perioperativen Aufenthalt auszudehnen. Mit der Kenntnis um diese Notwendigkeit, der unablässigen Sensibilisierung für dieses Thema und der Vorhaltung entsprechender Ressourcen werden weiterhin Verbesserungen in der anästhesiologischen Patientenversorgung möglich sein. Ziel ist es, dieses Konzept zum integralen Bestandteil unseres täglichen Handelns werden zu lassen – dann gibt es keinen Zweifel an der Antwort auf die Frage: „Kann der Anästhesist das Outcome verbessern?“

Abstract

Despite anaesthesia-specific pharmacological and technological innovations in the last decades we are definitely aware that anaesthesia per se has the potential to induce changes in the balance of human physiology that in turn may have relevant consequences, i.e. an increase in postoperative morbidity and mortality. Today anaesthesia appears to be extremely safe, with the number of deaths solely attributed to anaesthesia having reached its lowest point in history (0.055 per 10 000 anaesthetics). However, the available data regarding anaesthesia-related mortality, solely or contributory, are not consistent and the interpretation and legibility is limited. Fortunately, the issue of “patient safety in anaesthesiology” has gained increasing interest in the last few years, yielding some very promising projects. Since most of the ideas are focused on intraoperative safety improvement strategies, it seems to be reasonable in the near future to expand to the complete perioperative period, especially the postoperative care on the ward in high-risk patients. This knowledge, combined with an ongoing promotion of patient safety in anaesthesiology and provision of adequate resources definitely will increase patient safety. Hopefully, in the end, our efforts will contribute to integrate the “patient safety in anaesthesiology concept” in daily clinical routine.

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• Supplementary Material