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Zusammenfassung

     Welche Fragen kommen bei interessierten Anästhesisten auf, wenn es um das Thema Narkosetiefemessung geht? Häufig wird man mit folgenden Fragen konfrontiert: Der verwendete Monitor zeigte eine ausreichende Narkosetiefe an und der Patient hat dennoch auf den Hautschnitt reagiert oder der Patient hat zum Ende der Narkose bereits die Augen geöffnet, dennoch gab der Monitor ein Stadium ausreichender Narkosetiefe an. Wie soll das funktionieren? Andere Fragen richten sich nach der Wahl des Monitors und ob man ein postoperatives Delir verhindern kann sowie ob grundsätzlich ein EEG-Monitoring verwendet werden soll oder ob es nicht auch verzichtbar sei. Diesen und anderen Fragen soll im Folgenden nachgegangen werden und die Narkosetiefemessung vor dem Hintergrund der vorhandenen Literatur beleuchtet werden. Abstract Based on the existing literature, the application of designated, processed EEG-monitors to measure anesthetic depth and the associated clinical implications are explained. EEG-monitors quantify the hypnotic portion of anesthesia, but not the nociceptive properties of anesthetics. Depth of anesthesia monitoring is common practice in many German hospitals and helps to visualize the interindividual variability of anesthetics, especially of propofol. Although deep anesthesia is associated with increased long-term mortality, this relation seems not to be causally related. Nevertheless, depth of anesthesia monitors help to identify patients being especially susceptible to anesthetics. Moreover, they have shown to reduce the incidence of intraoperative awareness and postoperative delirium. The application of processed EEG-monitors to reduce the incidence of postoperative delirium is currently recommended by the European Society of Anaesthesiology and Intensive Care. Kernaussagen Narkosetiefemessung gehört inzwischen in vielen OP-Sälen in Deutschland zum Standard und hilft insbesondere bei totaler intravenöser Anästhesie (TIVA), die interindividuelle Variabilität des Propofolverbrauchs sichtbar zu machen. Insbesondere bei TIVA (in Kombination mit einem Muskelrelaxans) reduziert die Narkosetiefemessung die Inzidenz von Awareness und kann daher empfohlen werden. Bei Gasnarkosen hilft auch die Alarmierung bei endexspiratorischen Gaskonzentrationen < 0,5 MAC. EEG-Monitore messen lediglich den hypnotischen Anteil der Narkose und dienen nicht der Messung von Nozizeption. Das EEG kann daher bei 0,5–1 MAC durchaus eine ausreichende Narkosetiefe anzeigen, obwohl ohne ein Analgetikum > 50% der Patienten auf einen Schmerzreiz mit einer Abwehrreaktion reagieren würden. Tiefe EEG-Narkosetiefe-Indices sind mit einer erhöhten postoperativen Sterblichkeit assoziiert, wobei eine strikte Vermeidung zu tiefer Narkosen durch die Anwendung von Narkosetiefemonitoren die postoperative Mortalität in prospektiven Studien nicht reduzieren konnte. Tiefe EEG-Narkosetiefe-Indices und Burst-Suppression-EEG korrelieren mit einer höheren Inzidenz eines postoperativen Delirs. Ob die strikte Vermeidung zu tiefer Narkosen durch die Anwendung von Narkosetiefemonitoren die Inzidenz eines Delirs reduzieren kann, ist noch nicht zweifelsfrei nachgewiesen, sie werden aber von der ESAIC empfohlen. Schlüsselwörter Narkosetiefe - intraoperatives Monitoring - Elektroenzephalografie - EEG Keywords anesthetic depth - intraoperative monitoring - electroencephalography - EEG 06 December 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Literatur 1 Sandin RH, Enlund G, Samuelsson P. et al. 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