{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T23:23:26Z","timestamp":1787354606681,"version":"build-2736575974"},"reference-count":68,"publisher":"Georg Thieme Verlag KG","issue":"S 01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Zentralbl Chir"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title>\n                  <jats:p>Thoraxchirurgische Eingriffe stellen die An\u00e4sthesiologie vor besondere\n\t\t\tHerausforderungen. Die in diesem Kontext regelhaft notwendige Einlungenventilation (ELV)\n\t\t\tverbessert zwar die chirurgische Exposition, f\u00fchrt jedoch zu charakteristischen\n\t\t\tpathophysiologischen Ver\u00e4nderungen: Der Rechts-links-Shunt nimmt zu, die\n\t\t\tTotraumventilation steigt, und durch die hypoxische pulmonale Vasokonstriktion (HPV)\n\t\t\terh\u00f6ht sich der pulmonale Gef\u00e4\u00dfwiderstand. Diese Mechanismen wirken sich unmittelbar auf\n\t\t\tH\u00e4modynamik und Gasaustausch aus und erfordern eine differenzierte an\u00e4sthesiologische\n\t\t\tStrategie. Ein Vergleich zwischen der Durchf\u00fchrung einer totalen intraven\u00f6sen An\u00e4sthesie\n\t\t\t(TIVA) und einer balancierten Allgemeinan\u00e4sthesie zeigt, dass beide Verfahren\n\t\t\tspezifische Vor- und Nachteile aufweisen, die unter den Bedingungen der ELV sowie unter\n\t\t\tBer\u00fccksichtigung individueller Patient*innenfaktoren sorgf\u00e4ltig abzuw\u00e4gen sind. W\u00e4hrend\n\t\t\tdie TIVA eine geringere Beeinflussung der HPV sowie durch eine geringere Umweltbelastung\n\t\t\tVorteile bieten kann, erm\u00f6glicht die balancierte Allgemeinan\u00e4sthesie mit der Kombination\n\t\t\taus volatilen Inhalationsan\u00e4sthetika wie Desfluran oder Sevofluran und intraven\u00f6s\n\t\t\tverabreichten Medikamenten (Opioide, Muskelrelaxanzien, Hypnotika) ein pr\u00e4ziseres\n\t\t\tpharmakologisches Monitoring. Zudem k\u00f6nnen volatile Inhalationsan\u00e4sthetika insbesondere\n\t\t\tbei Patient*innen mit eingeschr\u00e4nkter kardiozirkulatorischer Funktion von Vorteil sein.\n\t\t\tWeiter tragen Operationss\u00e4le erheblich zu den CO2-Emissionen des\n\t\t\tGesundheitssystems bei, wobei insbesondere Desfluran, in geringerem Ma\u00dfe auch\n\t\t\tSevofluran, einen relevanten Anteil verursacht. Low-Flow-Techniken k\u00f6nnen hierbei die\n\t\t\tEmissionen reduzieren, dennoch gelten intraven\u00f6se Verfahren wie die TIVA oder\n\t\t\tRegionalan\u00e4sthesien als \u00f6kologisch g\u00fcnstiger. Hinzu kommen Belastungen durch den hohen\n\t\t\tVerbrauch von Einwegmaterialien sowie den betr\u00e4chtlichen Energiebedarf der\n\t\t\tInfrastruktur. Die bisherige Evidenz ist diesbez\u00fcglich jedoch heterogen, sodass weitere\n\t\t\tsystematische Untersuchungen erforderlich sind. Die Wahl des An\u00e4sthesieverfahrens ist\n\t\t\tdamit nicht nur eine medizinische, sondern zunehmend auch eine \u00f6kologische Entscheidung.\n\t\t\tZiel der vorliegenden Arbeit ist es, die verf\u00fcgbare Evidenz aus randomisierten\n\t\t\tkontrollierten Studien und systematischen Reviews zu TIVA und balancierter\n\t\t\tAllgemeinan\u00e4sthesie in der Thoraxchirurgie strukturiert zu analysieren und\n\t\t\tgegen\u00fcberzustellen. Neben klinischen Endpunkten werden dabei auch \u00f6kologische,\n\t\t\tinflammatorische und patientenspezifische Aspekte ber\u00fccksichtigt, um eine fundierte\n\t\t\tGrundlage f\u00fcr zuk\u00fcnftige Entscheidungsprozesse zu schaffen.<\/jats:p>","DOI":"10.1055\/a-2841-7020","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T22:59:42Z","timestamp":1776207582000},"page":"S17-S27","source":"Crossref","is-referenced-by-count":1,"special_numbering":"S","title":["Totale intraven\u00f6se An\u00e4sthesie oder balancierte Allgemeinan\u00e4sthesie: Pros und Contras in der Thoraxchirurgie"],"prefix":"10.1055","volume":"151","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3485-486X","authenticated-orcid":false,"given":"Jonas","family":"Weber","sequence":"additional","affiliation":[{"name":"Klinikum der Universit\u00e4t Witten\/Herdecke, Kliniken K\u00f6ln gGmbH, NRW, Deutschland","place":["K\u00f6ln"],"department":["Klinik f\u00fcr An\u00e4sthesiologie und operative Intensivmedizin"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Wappler","sequence":"additional","affiliation":[{"name":"Klinikum der Universit\u00e4t Witten\/Herdecke, Kliniken K\u00f6ln gGmbH, NRW, Deutschland","place":["K\u00f6ln"],"department":["Klinik f\u00fcr An\u00e4sthesiologie und operative Intensivmedizin"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Schieren","sequence":"additional","affiliation":[{"name":"Klinikum der Universit\u00e4t Witten\/Herdecke, Kliniken K\u00f6ln gGmbH, NRW, Deutschland","place":["K\u00f6ln"],"department":["Klinik f\u00fcr An\u00e4sthesiologie und operative Intensivmedizin"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00f4me","family":"Defosse","sequence":"additional","affiliation":[{"name":"Klinikum der Universit\u00e4t Witten\/Herdecke, Kliniken K\u00f6ln gGmbH, NRW, Deutschland","place":["K\u00f6ln"],"department":["Klinik f\u00fcr 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