Zusammenfassung
Die Minimierung des perioperativen kardiovaskulären Risikos durch medikamentöse Interventionen spielt in der Anästhesie eine wichtige Rolle. So hat z. B. die Therapie mit β-Blockern inzwischen einen festen Stellenwert in der perioperativen anästhesiologischen Behandlung erlangt. In der Literatur gibt es eine zunehmende Fülle an Hinweisen auf einen myokardprotektiven Effekt der volatilen Anästhetika. Dieses Phänomen wird mit dem Begriff der anästhetikainduzierten Präkonditionierung (AP) beschrieben. Tierexperimentelle Daten sind vielfältig und komplex. Die Mechanismen der anästhetikainduzierten Kardioprotektion wurden eingehend untersucht, sind aber letztlich nicht abschließend geklärt. Auch erste klinische Daten belegen einen protektiven Effekt der inhalativen Anästhetika anhand von myokardialen Funktions- und Schädigungsparametern. Daher stellt sich für den klinisch tätigen Anästhesisten die Frage einer praktischen Relevanz für die Narkoseführung bei Patienten mit entsprechendem Risikoprofil. Die vorliegende Arbeit gibt einen Überblick über die derzeitigen wissenschaftlichen Ergebnisse mit einer Fokussierung auf die Mechanismen der anästhesiologischen Präkonditionierung und auf klinische Untersuchungen.
Abstract
Reduction of the perioperative cardiovascular risk with pharmacological interventions plays a prominent role in routine anesthesia practice. For example, perioperative beta-blockade is well established in anesthesiological treatment of patients. There is a growing body of evidence supporting the cardioprotective effects of volatile anesthetics known as anesthetic-induced preconditioning. There are numerous and complex data from animal studies. The mechanisms of anesthetic-induced preconditioning have been extensively studied but have still not been clearly identified. Initial clinical data show the cardioprotective effects of volatile agents by looking at parameters of myocardial function and laboratory values and therefore, the question of the relevance of these data for routine clinical practice has been raised. This review gives a summary of the currently available data focusing on the mechanisms of anesthesiological preconditioning and clinical studies.
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Buchinger, H., Grundmann, U. & Ziegeler, S. Myokardiale Präkonditionierung durch volatile Anästhetika. Anaesthesist 54, 861–870 (2005). https://doi.org/10.1007/s00101-005-0902-6
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DOI: https://doi.org/10.1007/s00101-005-0902-6