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Perioperative Kardioprotektion

Goldstandard β-Blockade?

Perioperative cardioprotection

Golden standard β-blockade?

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Zusammenfassung

Myokardiale Ischämien zählen zu den wichtigsten Determinanten perioperativer Morbidität und Letalität. Entsprechend werden perioperativ verschiedene kardioprotektive Maßnahmen eingesetzt, um der mit der Lebenserwartung steigenden Anzahl chirurgischer Patienten mit kardiovaskulärem Risiko zu begegnen. Der Schwerpunkt liegt hierbei auf der perioperativen β-Blockade. Obwohl nach Ansicht vieler Autoren eine perioperative β-Blockade bei Hochrisikopatienten eine effektive protektive Maßnahme darstellt, herrscht weitgehend Unklarheit über die Art und Dauer der β-Blockade sowie darüber, welche Patienten von einer perioperativen β-Blockade profitieren. Basierend auf den aktuell verfügbaren Daten werden Fragen zur praktischen Umsetzung diskutiert wie bevorzugte Substanzen, Beginn und Ende der Therapie, unerwünschte Wirkungen, Identifizierung von Risikopatienten sowie ökonomische Aspekte. Eine weitere Stoffklasse kardioprotektiver Substanzen sind die Statine. Neben der lipidsenkenden Wirkung werden ihnen sog. pleiotrope Mechanismen zugeschrieben, die ebenfalls das kardiovaskuläre Risiko vermindern. Weitere Maßnahmen, welche alternativ oder in Kombination mit einer perioperativen β-Blockade eingesetzt werden können, sind α2-Agonisten, eine thorakale Epiduralanalgesie oder eine koronare Revaskularisierung.

Abstract

Myocardial ischemia is a major cause of perioperative morbidity and mortality. Because of a growing expectancy of lives, the prevalence of cardiovascular diseases is increasing, and thus the number of surgical patients presenting with a cardiovascular risk profile. Based upon pathophysiological considerations, different interventions to lower perioperative cardiovascular risk have been evaluated. The mostly discussed intervention believed to prevent cardiovascular complications in the perioperative period is the use of beta-blockers. Although many authors agree that perioperative beta-blockade is effective in high-risk patients, less is known about the optimal timing, dosage and the identification of patients in whom the intervention would be beneficial. Based upon the available data we try to answer questions about timing and dosage, and we discuss possible side effects and economic questions. Another cardioprotective option is the use of statins. Besides their lipid-lowering properties, so called pleiotropic effects are believed to decrease cardiac risk. Furthermore, different interventions can be used in addition to or as an alternative to perioperative beta-blocker therapy, such as alpha-2 agonists, thoracic epidural analgesia or coronary revascularization.

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  1. Klinik für Anaesthesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    Nils Butte, B.W. Böttiger & P. Teschendorf

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  1. Nils Butte
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Butte, N., Böttiger, B. & Teschendorf, P. Perioperative Kardioprotektion. Anaesthesist 56, 285–298 (2007). https://doi.org/10.1007/s00101-007-1144-6

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