Zusammenfassung
Hintergrund:
Die Mikrozirkulation bei kritisch Kranken ist zunehmend in das Interesse intensivmedizinischer Forschung gerückt, da hierdurch frühzeitig Veränderungen der Gewebeperfusion sichtbar werden. Bei Kurzzeitanästhesie konnte kürzlich ein negativer Einfluss bei der Infusion von Propofol auf die Mikrozirkulation nachgewiesen werden. Der Einfluss von Propofol auf den Mikrofluss bei internistischen Intensivpatienten unter Langzeitanästhesie ist bislang unklar.
Patienten und Methodik:
Bei 28 Patienten (elf mit Propofol) der eigenen internistischen Intensivstation wurde mittels Sidestream-Darkfield-Mikroskopie der sublinguale Mikrofluss visualisiert, aufgezeichnet und quantifiziert (0: „no flow“; 1: „intermittent flow“; 2: „sluggish flow“; 3: „continuous flow“).
Ergebnisse:
Bei stabilen internistischen Intensivpatienten konnten in sublingualen Gefäßen (10–100 μm) gute Mikroflüsse nachgewiesen werden, bei vielen Patienten nahezu kontinuierliche Flüsse. Dabei unterschieden sich Patienten mit und ohne Propofol nicht.
Schlussfolgerung:
Bei stabilen Patienten zeigte sich in dieser kleinen Kohorte kein Einfluss von Propofol im Langzeiteinsatz auf den Mikrofluss. Die bekannte Interaktion zwischen Propofol und Mikrozirkulation sollte der Intensivmediziner dennoch kennen und den Einsatz dieser Präparate bei Patienten mit Schock zu vermeiden versuchen. Der Einsatz von Propofol bei hämodynamisch kompromittierten Patienten sollte in zukünftigen Studien untersucht werden.
Abstract
Background:
Microcirculation has become a major focus of research in critical care medicine due to its growing clinical relevance detecting changes in organ perfusion at an early stage. A negative impact of propofol infusion on microcirculation during short-term anesthesia was described recently. The influence of long-term sedation with propofol on microflow of critical care patients is still unclear.
Patients and Methods:
Microflow was analyzed using sidestream darkfield microscopy of sublingual mucosa in 28 patients of whom eleven received continuous infusion of propofol. According to current guidelines, microflow was recorded digitally. Quantitative analysis was performed offline in a semiquantitative way (0: no flow; 1: intermittent flow; 2: sluggish flow; 3: continuous flow).
Results:
Good microflow rates were detected in sublingual vessels (10–100 μm) in hemodynamically stable, medical intensive care patients. In the majority of cases, continuous flow profiles were recorded. There was no difference in flow rates between patients with and without propofol therapy.
Conclusion:
In hemodynamically stable intensive care patients, long-term therapy with propofol did not affect sublingual microflow in this small cohort. However, intensive care physicians should keep such possible interactions in mind avoiding administration of these substances in patients with manifested shock. The effects of propofol in hemodynamically impaired patients should be evaluated in further studies.
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Jung, C., Rödiger, C., Lauten, A. et al. Die Langzeitgabe von Propofol hat keinen Einfluss auf die Mikrozirkulation bei internistischen Intensivpatienten. Med Klin 104, 336–342 (2009). https://doi.org/10.1007/s00063-009-1071-1
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DOI: https://doi.org/10.1007/s00063-009-1071-1