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Incidenti in anestesia

Anestesia & analgosedazione

Per professionisti sanitari. Le informazioni non sostituiscono la valutazione clinica del singolo caso; fanno fede il riassunto delle caratteristiche del prodotto aggiornato e le linee guida citate.

Revisione medica: Dr. med. univ. Daniel Pehböck, DESA, 03.11.2026

Incidenti in anestesia: Desaturazione – DOPES, Laringospasmo, Broncospasmo, Aspirazione, Ipotensione e bradicardia all'induzione dell'anestesia, Anestesia spinale alta o totale – in sintesi per i team di emergenza, anestesia e terapia intensiva, con fonti e revisione medica.

Contenuto del capitolo

  1. Desaturazione – DOPES
  2. Laringospasmo
  3. Broncospasmo
  4. Aspirazione
  5. Ipotensione e bradicardia all'induzione dell'anestesia
  6. Anestesia spinale alta o totale
  7. Anafilassi perioperatoria
  8. Ipertermia maligna (IM)
  9. Tossicità sistemica da anestetici locali (LAST)
  10. Curarizzazione residua
  11. Vie aeree difficili impreviste
  12. Arresto cardiaco perioperatorio (ERC 2025)

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Farmaci in questo capitolo

Fonti e linee guida

  1. Lott C et al. European Resuscitation Council Guidelines 2025: Special Circumstances in Resuscitation. Resuscitation 2025;215 Suppl 1:110753.
  2. Soar J, Böttiger BW et al. European Resuscitation Council Guidelines 2025 Adult Advanced Life Support. Resuscitation 2025;215 Suppl 1:110769 (Korrigendum 2026).
  3. Djakow J, Turner NM, Skellett S et al. European Resuscitation Council Guidelines 2025 Paediatric Life Support. Resuscitation 2025;215 Suppl 1:110767.
  4. Association of Anaesthetists. Quick Reference Handbook (QRH)
  5. Royal College of Anaesthetists. 7th National Audit Project (NAP7): Perioperative cardiac arrest, 11/2023 (881 Fälle; häufigste Ursachen schwere Blutung 17 %, Bradyarrhythmie 9,4 %, Myokardischämie 7,3 %; initial nicht defibrillierbar 82 %; Kinder.
  6. Harper NJN, Nolan JP, Soar J, Cook TM. Why chest compressions should start when systolic arterial blood pressure is below 50 mm Hg in the anaesthetised patient. Br J Anaesth 2020 (Thoraxkompression bei RR syst. < 50 mmHg trotz Therapie beim narkotisierten Erwachsenen).
  7. Gavel G, Walker RWM. Laryngospasm in anaesthesia. Contin Educ Anaesth Crit Care Pain 2014;14:47–51 (Propofol in Schritten von 0,5 mg/kg; Suxamethonium 0,1–2 mg/kg löst den Laryngospasmus).
  8. UK-SmPC Suxamethonium Chloride 50 mg/ml Solution for Injection (emc), Abschnitt 4.2: Kinder i.v.
  9. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention.
  10. Anaesthesiologic management of patients at risk of pulmonary aspiration.
  11. Harper NJN, Cook TM, Garcez T et al. Anaesthesia, surgery, and life-threatening allergic reactions.
  12. Dodd A, Turner PJ, Soar J, Savic L (UK Perioperative Allergy Network). Emergency treatment of peri-operative anaphylaxis: Resuscitation Council UK algorithm for anaesthetists. Anaesthesia 2024;79:535–541 (Adrenalin i.v. 1. Wahl, Erwachsene und Kinder ≥ 12 J. 50 µg als Bolus; bei Persistenz Adrenalin-Infusion statt wiederholter Boli.
  13. Resuscitation Council UK. Peri-operative anaphylaxis algorithm (01/2024, mit der Association of Anaesthetists): Adrenalin i.v. 50 µg (0,5 ml 1:10 000) für Erwachsene und Kinder „12 years and over“; Adrenalin-Infusion 0,5 mg in 50 ml, Start 0,5–1 ml/kg/h (Erwachsene und Kinder); CPR bei RR syst. < 50 mmHg.
  14. Garvey LH, Dewachter P, Hepner DL et al. Management of suspected immediate perioperative allergic reactions.
  15. Sugammadex-induced anaphylactic reaction.
  16. Vitte J et al. Use and interpretation of acute and baseline tryptase in perioperative hypersensitivity and anaphylaxis. J Allergy Clin Immunol Pract 2021.
  17. Glahn KPE et al. Recognition and management of a malignant hyperthermia crisis.
  18. Glahn KPE, Bendixen D, Girard T et al. (EMHG). Availability of dantrolene for the management of malignant hyperthermia crises: European Malignant Hyperthermia Group guidelines. Br J Anaesth 2020;125:133–140 (Dosis nach tatsächlichem Körpergewicht, initial max. 300 mg; Unterdosierung mit schlechterem Verlauf assoziiert; Vorrat für die sofortige Initialdosis).
  19. DGAI. S1-Leitlinie Therapie der malignen Hyperthermie, AWMF-Register 001-008, Fassung 03/2018 (DGAI-Präsidium 24.11.2017, DIVI 20.12.2017; Anästh Intensivmed 2018;59:204–208)
  20. Hopkins PM, Girard T, Dalay S et al. Malignant hyperthermia 2020: Guideline from the Association of Anaesthetists. Anaesthesia 2021;76:655–664.
  21. Resuscitation Council UK. Special circumstances guidelines.
  22. Deutsche MH-Hotline (rund um die Uhr), SRH Kliniken Landkreis Sigmaringen (Leitung W. Klingler): 07571 100-2828.
  23. Medizinische Universität Wien / AKH Wien: MH-Diagnose- und Forschungszentrum, von der EMHG akkreditiert (Meldung 07/2019; im EMHG-Verzeichnis der MH-Units einzige gelistete österreichische Einheit). 24-h-Hotline siehe nz-mh-hotline-at. Abgerufen 03.11.2026.
  24. Medizinische Universität Wien / AKH Wien, Klinische Abteilung für Spezielle Anästhesie und Schmerztherapie.
  25. Neal JM, Neal EJ, Weinberg GL. American Society of Regional Anesthesia and Pain Medicine Local Anesthetic Systemic Toxicity checklist: 2020 version. Reg Anesth Pain Med 2021;46:81–82.
  26. Association of Anaesthetists of Great Britain and Ireland (AAGBI). Safety Guideline: Management of Severe Local Anaesthetic Toxicity. London 2010.
  27. DGAI. S1-Leitlinie Prävention & Therapie der systemischen Lokalanästhetika-Intoxikation (LAST), AWMF-Register 001-044, Anästh Intensivmed 2020;61:225–238.
  28. Fuchs-Buder T, Romero CS, Lewald H et al. Peri-operative management of neuromuscular blockade.
  29. Ahmad I et al. Difficult Airway Society 2025 guidelines for management of unanticipated difficult tracheal intubation in adults. Br J Anaesth 2026;136(1):283–307 (Epub 07.11.2025, PubMed 41203471), Algorithmus Plan A–D.
  30. Riassunti delle caratteristiche dei prodotti autorizzati – prodotto e sezione per ogni dose nell'app.