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Spezielle Aspekte der anästhesiologischen Pharmakotherapie

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Pharmakotherapie in der Anästhesie und Intensivmedizin

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Zusammenfassung

Der derzeitige Kenntnisstand zur Prophylaxe und Therapie ischämischer Schäden des Gehirns beruht im Wesentlichen auf Ergebnissen aus Tierversuchen. Ischämien im Gehirn verursachen eine Reihe von Prozessen, die zum Zelluntergang führen. Dazu gehören neben vielen anderen die Freisetzung exzitatorischer Transmitter, die verzögerte neuronale Nekrose, die selektive Vulnerabilität, Apoptose, die ischämische Penumbra, die Schädigung durch freie Radikale, die verzögerte Hypoperfusion, pharmakologische Effekte von Anästhetika auf den zerebralen Blutfluss sowie den Zellmetabolismus. Aus klinischen Untersuchungen ist bekannt, dass Patienten, die sich einem chirurgischen Eingriff unterziehen müssen gegenüber nichthospitalisierten Patienten eine leicht erhöhte Schlaganfallshäufigkeit aufweisen. Allerdings stellt die perioperative Phase eine hochkomplexe Situation dar, in der sich kausale Effekte von Schädigung, Prävention und Therapie nicht immer leicht herausarbeiten lassen. Dies liegt nicht zuletzt daran, dass die Patienten anästhesiert sind, also auf der einen Seite potenziell geschützt sind vor ischämischen Schäden, auf der anderen Seite aber keine frühzeitige neurologische Diagnostik erlauben, die am wachen Patienten möglich ist. Dementsprechend können nur wenige klare und gut belegte Aussagen zur zerebralen Protektion getroffen werden.

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Literatur

  1. Balki M, Dhumne S, Kasodekar S et al. Oxytocin-ergometrine coadministration does not reduce blood loss at caesarean delivery for labour arrest. Bjog 2008;115:579–84

    Article  PubMed  CAS  Google Scholar 

  2. Balki M, Ronayne M, Davies S et al. Minimum oxytocin dose requirement after cesarean delivery for labor arrest. Obstet Gynecol 2006;107:45–50

    Article  PubMed  CAS  Google Scholar 

  3. Bedford PD. Adverse cerebral effects of anaesthesia on old people. Lancet 1955;269:259–63

    Article  PubMed  CAS  Google Scholar 

  4. Boivin JF. Risk of spontaneous abortion in women occupationally exposed to anaesthetic gases: a meta-analysis. Occup Environ Med 1997;54:541–8

    Article  PubMed  CAS  Google Scholar 

  5. Bracken MB, Shepard MJ, Holford TR et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA 1997;277:1597–604

    Article  PubMed  CAS  Google Scholar 

  6. Briegel J. [Cortisone substitution in sepsis. Is less more?]. Anaesthesist2003;52 Suppl 1:S24–31

    Google Scholar 

  7. Bucklin BA. Gerard W. Ostheimer„what's new in obstetric anesthesia“ lecture. Anesthesiology 2006;104:865–71

    Article  PubMed  Google Scholar 

  8. Buckner RL. Memory and executive function in aging and AD: multiple factors that cause decline and reserve factors that compensate. Neuron 2004;44:195–208

    Article  PubMed  CAS  Google Scholar 

  9. Campbell DC, Camann WR, Datta S. The addition of bupivacaine to intrathecal sufentanil for labor analgesia. Anesth Anaig 1995;81305–9

    Google Scholar 

  10. Carvalho JC, Balki M, Kingdom J, Windrim R. Oxytocin requirements at elective cesarean delivery: a dose-finding study. Obstet Gynecol 2004;104:1005–10

    Article  PubMed  CAS  Google Scholar 

  11. Coles JP, Minhas PS, Fryer TD et al. Effect of hyperventilation on cerebral blood flow in traumatic head injury: clinical relevance and monitoring correlates. Crit Care Med 2002;30:1950–9

    Article  PubMed  CAS  Google Scholar 

  12. Culley DJ, Baxter M, Yukhananov R, Crosby G. The memory effects of general anesthesia persist for weeks in young and aged rats. Anesth Anaig 2003;96:1004–9, table of contents

    Google Scholar 

  13. Culley DJ, Baxter MG, Yukhananov R, Crosby G. Long-term impairment of acquisition of a spatial memory task following isoflurane-nitrous oxide anesthesia in rats. Anesthesiology 2004;100:309–14

    Article  PubMed  CAS  Google Scholar 

  14. Davies AM. Regulation of neuronal survival and death by extracellular signals during development. EMBO J 2003;22:2537–45

    Article  PubMed  CAS  Google Scholar 

  15. De Baerdemaeker LE, Jacobs S, Den Blauwen NM et al. Postoperative results after desflurane or sevoflurane combined with remifentanil in morbidly obese patients. Obes Surg 2006;16:728–33

    Article  PubMed  Google Scholar 

  16. Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, Berufsverband Deutscher Anästhesisten, in Zusammenarbeit mit der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe. Durchführung von Analgesie- und Anästhesieverfahren in der Geburtshilfe, 2. Überarb. Empfehlungen. Anaesthesiol Intensivmed 2009;50:S490–5

    Google Scholar 

  17. Eckenhoff JE. Relationship of anesthesia to postoperative personality changes in children. AMA Am J Dis Child 1953;86:587–91

    PubMed  CAS  Google Scholar 

  18. Ellis DJ, Millar WL, Reisner LS. A randomized double-blind comparison of epidural versus intravenous fentanyl infusion for analgesia after cesarean section. Anesthesiology 1990;72:981–6

    Article  PubMed  CAS  Google Scholar 

  19. Ergina PL, Gold SL, Meakins JL. Perioperative care of the elderly patient. World J Surg 1993,17:192–8

    Article  PubMed  CAS  Google Scholar 

  20. Fräser CG, Preuss FS, Bigford WD. Adrenal atrophy and irreversible shock associated with cortisone therapy. J Am Med Assoc 1952,149:1542–3

    Article  PubMed  Google Scholar 

  21. Fredman B, Sheffer O, Zohar E etal. Fast-track eligibility of geriatric patients undergoing short urologic surgery procedures. Anesth Anaig 2002;94:560–4; table of contents

    Google Scholar 

  22. Gentile NT, Seftchick MW, Huynh T et al. Decreased mortality by normalizing blood glucose after acute ischemic stroke. Acad Emerg Med 2006;13:174–80

    Article  PubMed  Google Scholar 

  23. Glass PS, Estok P, Ginsberg B et al. Use of patient-controlled analgesia to compare the efficacy of epidural to intravenous fentanyl administration. Anesth Analg 1992;74:345–51

    Article  PubMed  CAS  Google Scholar 

  24. Gruchalla RS. Drug allergy. Curr Opin Allergy Clin Immunol 2002;2:295–6

    Article  PubMed  Google Scholar 

  25. Guinard JP, Mavrocordatos P, Chiolero R, Carpenter RL. A randomized comparison of intravenous versus lumbar and thoracic epidural fentanyl for analgesia after thoracotomy. Anesthesiology 1992;77:1108–15

    Article  PubMed  CAS  Google Scholar 

  26. Haj RM, Cinco JE, Mazer CD. Treatment of pulmonary hypertension with selective pulmonary vasodilators. Curr Opin Anaesthesiol 2006;19:88–95

    Article  PubMed  Google Scholar 

  27. Hanania M, Kitain E. Melatonin for treatment and prevention of postoperative delirium. Anesth Analg 2002;94:338–9, table of contents

    Google Scholar 

  28. Haraldsson A, Kieler-Jensen N, Nathorst-Westfelt U et al. Comparison of inhaled nitric oxide and inhaled aerosolized prostacyclin in the evaluation of heart transplant candidates with elevated pulmonary vascular resistance. Chest 1998;114:780–6

    Article  PubMed  CAS  Google Scholar 

  29. Härtung J. Of mice and men and type II errors. Anesthesiology 2006;104:206; author reply

    Google Scholar 

  30. Hauser WA, Annegers JF, Kurland LT. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia 1993;34:453–68

    Article  PubMed  CAS  Google Scholar 

  31. Jage J, Heid F. [Anesthesia and analgesia in addicts: basis for establishing a standard operating procedure]. Anaesthesist 2006;55:611–28

    Google Scholar 

  32. Jevtovic-Todorovic V, Carter LB. The anesthetics nitrous oxide and ketamine are more neurotoxic to old than to young rat brain. Neurobiol Aging 2005;26:947–56

    Article  PubMed  CAS  Google Scholar 

  33. Kehlet H, Binder C. Adrenocortical function and clinical course during and after surgery in unsupplemented glucocorticoidtreated patients. Br J Anaesth 1973;45:1043–8

    Article  PubMed  CAS  Google Scholar 

  34. Kunitz O, Frank J. [Anesthesiologic management of patients with acute porphyria]. Anaesthesist 2001;50:957–66; quiz 67–9

    Google Scholar 

  35. Lalau JD, Race JM. Lactic acidosis in metformin therapy: searching for a link with metformin in reports of ‘metformin-associated lactic acidosis’. Diabetes Obes Metab 2001;3:195–201

    Article  PubMed  CAS  Google Scholar 

  36. Lennox PH, Henderson CL. Herbal medicine use in ambulatory surgery patients in Canada. Can J Anaesth 2002;49:A93

    Google Scholar 

  37. Lerchl-Wanie G, Angster R (2010)„[Perioperative analgesia for opioid tolerant patients].“ Anaesthesist 59:657–670

    Article  PubMed  CAS  Google Scholar 

  38. Leskiw U, Weinberg GL. Lipid resuscitation for local anesthetic toxicity: is it really lifesaving? Curr Opin Anaesthesiol 2009;22:667–71

    Article  PubMed  Google Scholar 

  39. Lewis L, Robinson RF, Yee J et al. Fatal adrenal cortical insufficiency precipitated by surgery during prolonged continuous cortisone treatment. Ann Intern Med 1953;39:116–26

    PubMed  CAS  Google Scholar 

  40. Loper KA, Ready LB, Downey M et al. Epidural and intravenous fentanyl infusions are clinically equivalent after knee surgery. Anesth Anaig 1990;70:72–5

    Article  CAS  Google Scholar 

  41. Macario A, Dexter F, Lubarsky D. Meta-analysis of trials comparing postoperative recovery after anesthesia with sevoflurane or desflurane. Am J Health Syst Pharm 2005;62:63–8

    PubMed  CAS  Google Scholar 

  42. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc 2001;49:516–22

    Article  PubMed  CAS  Google Scholar 

  43. Martin J, Heymann A, Basell K et al. Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care-short version. Ger Med Sci 2010;8:Doc02

    Google Scholar 

  44. Mellon RD, Simone AF, Rappaport BA. Use of anesthetic agents in neonates and young children. Anesth Anaig 2007;104:509–20

    Article  CAS  Google Scholar 

  45. Miguel R, Barlow I, Morrell M et al. A prospective, randomized, double-blind comparison of epidural and intravenous sufentanil infusions. Anesthesiology 1994;81:346–52; discussion 25A–26A

    Google Scholar 

  46. Milde AS, Bottiger BW, Morcos M. [Adrenal cortex and steroids. Supplementary therapy in the perioperative phase]. Anaesthesist 2005;54:639–54

    Article  PubMed  CAS  Google Scholar 

  47. Mitra S, Sinatra RS. Perioperative management of acute pain in the opioid-dependent patient. Anesthesiology 2004;101:212–27

    Article  PubMed  Google Scholar 

  48. Mo11er JT, Cluitmans P, Rasmussen LS et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet 1998;351:857–61

    Article  PubMed  CAS  Google Scholar 

  49. Muizelaar JP, Marmarou A, Ward JD et al. Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg 1991;75:731–9

    Article  PubMed  CAS  Google Scholar 

  50. OIney JW, Young C, Wozniak DF et al. Anesthesia-induced developmental neuroapoptosis. Does it happen in humans? Anesthesiology 2004;101:273–5

    Article  Google Scholar 

  51. Paqueron X, Boccara G, Bendahou M et al. Brachial plexus nerve block exhibits prolonged duration in the elderly. Anesthesiology 2002;97:1245–9

    Article  PubMed  Google Scholar 

  52. Peters R. Ageing and the brain. Postgrad Med J 2006;82:84–8

    Article  PubMed  CAS  Google Scholar 

  53. Poblete Gutierrez P, Kunitz O, Wolff C, Frank J. Diagnosis and treatment of the acute porphyrias: an interdisciplinary challenge. Skin Pharmacol Appl Skin Physiol 2001;14:393–400

    Article  PubMed  CAS  Google Scholar 

  54. Reedy MB, Kallen B, Kuehl TJ. Laparoscopy during pregnancy: a study of five fetal outcome parameters with use of the Swedish Health Registry. Am J Obstet Gynecol 1997;177:673–9

    Article  PubMed  CAS  Google Scholar 

  55. Richards SS, Hendrie HC. Diagnosis, management, and treatment of Alzheimer disease: a guide for the internist. Arch Intern Med 1999;159:789–98

    Article  PubMed  CAS  Google Scholar 

  56. Rigal JC, Blanloeil Y. Anaesthesia and porphyria. Minerva Anestesiol 2002;68:326–31

    PubMed  CAS  Google Scholar 

  57. Rivera R, Antognini JF (2009) Perioperative drug therapy in elderly patientsAnesthesiology 110:1176–1181

    Article  PubMed  Google Scholar 

  58. Rosenblatt MA, Abel M, Fischer GW et al. Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology 2006;105:217–8

    Article  PubMed  Google Scholar 

  59. Salem M, Tainsh RE, Jr., Bromberg J et al. Perioperative glucocorticoid coverage. A reassessment 42 years after emergence of a problem. Ann Surg 1994;219:416–25

    CAS  Google Scholar 

  60. Salzman C. Medication compliance in the elderly. J Clin Psychiatry 1995;56 Suppl 1:18–22; discussion 3

    Google Scholar 

  61. Sarna MC, Soni AK, Gomez M, Oriol NE. Intravenous oxytocin in patients undergoing elective cesarean section. Anesth Anaig 1997;84:753–6

    CAS  Google Scholar 

  62. Scherbaum WA. [Metformin and anesthesia--how great is the risk of lactic acidosis]. Dtsch Med Wochenschr 2001;126:607–8

    Article  PubMed  CAS  Google Scholar 

  63. Scott-Levin SP. Top 200 brand-name drugs by units in 2001. Drug Topics 2002;5:38–45

    Google Scholar 

  64. Sheehan SR, Wedisinghe L, Macleod M, Murphy DJ. Implementation of guidelines on oxytocin use at caesarean section: a survey of practice in Great Britain and Ireland. Eur J Obstet Gynecol Reprod Biol;148:121–124

    Google Scholar 

  65. Steudel W, Hurford WE, Zapol WM. Inhaled nitric oxide: basic biology and clinical applications. Anesthesiology 1999;91:1090–121

    Article  PubMed  CAS  Google Scholar 

  66. Thomas TA, CooperGM (2002) Maternal deaths from anaesthesia. An extract from „Why mothers die 1997–1999“, the Confidential Enquiries into Maternal Deaths in the United Kingdom. Br J Anasth 89:499–508

    CAS  Google Scholar 

  67. Vallejo MC, Sah N, Phelps AL et al. Desflurane versus sevoflurane for laparoscopic gastroplasty in morbidly obese patients. J Clin Anesth 2007;19:3–8

    Article  PubMed  CAS  Google Scholar 

  68. Van den Berghe G, Wilmer A, Hermans G et al. Intensive insulin therapy in the medical ICU. N Engl J Med 2006;354:449–61

    Article  PubMed  Google Scholar 

  69. van den Berghe G, Wouters P, Weckers F et al. Intensive insulin therapy in the critically ill patients. N Engl J Med 2001;345:1359–67

    Article  PubMed  Google Scholar 

  70. Vaurio LE, Sands LP, Wang Y et al. Postoperative delirium: the importance of pain and pain management. Anesth Analg 2006;102:1267–73

    Article  PubMed  Google Scholar 

  71. Viby-Mogensen J, Ostergaard D, Donati F et al. Pharmacokinetic studies of neuromuscular blocking agents: good clinical research practice (GCRP). Acta Anaesthesiol Scand 2000;44:1169–90

    Article  PubMed  CAS  Google Scholar 

  72. von Keinbaum P, Peters J. [Perioperative metformin and lactacidosis]. Anaesthesist 2002;51:866–7

    Article  PubMed  CAS  Google Scholar 

  73. Walmrath D, Schneider T, Schermuly R et al. Direct comparison of inhaled nitric oxide and aerosolized prostacyclin in acute respiratory distress syndrome. Am J Respir Crit Care Med 1996;153:991–6

    PubMed  CAS  Google Scholar 

  74. Weuve J, Kang JH, Manson JE et al. Physical activity, including walking, and cognitive function in older women. JAMA 2004;292:1454–61

    Article  PubMed  CAS  Google Scholar 

  75. Wilson CJ, Finch CE, Cohen HJ. Cytokines and cognition—the case for a head-to-toe inflammatory paradigm. J Am Geriatr Soc 2002;50:2041–56

    Article  PubMed  Google Scholar 

  76. Xie Z, Dong Y, Maeda U et al. Isoflurane-induced apoptosis: a potential pathogenic link between delirium and dementia. J Gerontol A Biol Sei Med Sci 2006;61:1300–6

    Article  Google Scholar 

  77. Xie Z, Dong Y, Maeda U et al. The common inhalation anesthetic isoflurane induces apoptosis and increases amyloid beta protein levels. Anesthesiology 2006;104:988–94

    Article  PubMed  CAS  Google Scholar 

  78. Yokoo N, Sheng H, Mixco J et al. Intraischemic nitrous oxide alters neither neurologic nor histologic outcome: a comparison with dizocilpine. Anesth Analg 2004;99:896–903, table of contents

    Google Scholar 

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Authors and Affiliations

  1. Klinik für Anästhesie, operative und allgemeine Intensivmedizin, Notfallmedizin, Klinikum links der Weser GgmbH, Bremen, Senator-Weßling-Str. 1, 28277, Germany

    Prof. Dr. Peter H. Tonner

  2. Klinikum links der Weser, Herzzentrum Bremen, Bremen, Senator-Weßling-Str. 1, 28277, Germany

    Dr. Gerald Bandemer

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  1. Prof. Dr. Peter H. Tonner
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Editors and Affiliations

  1. Klinik für Anästhesie, operative und allg. Intensivmedizin, Notfallmedizin, Klinikum Links der Weser gGmbH, Senator-Weßling-Str. 1, 28277, Bremen

    Peter H. Tonner

  2. Klinik für Anästhesie und Intensivmedizin, Klinikum Bremen Nord gGmbH, Hammersbecker Str. 228, 28755, Bremen

    Peter H. Tonner

  3. Institut für Exp. u. Klin. Pharmakologie u. Toxikologie - Abt. II, Universität Freiburg, Albertstraße 25, 79104, Freiburg

    Lutz Hein

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Tonner, P.H., Bandemer, G. (2011). Spezielle Aspekte der anästhesiologischen Pharmakotherapie. In: Tonner, P.H., Hein, L. (eds) Pharmakotherapie in der Anästhesie und Intensivmedizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-79156-0_25

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  • DOI: https://doi.org/10.1007/978-3-540-79156-0_25

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