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Anästhesiologisches Management bei Implantation von Barorezeptorstimulatoren

Anesthesia management in implantation of baroreceptor stimulators

  • Allgemeinanästhesie
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Zusammenfassung

Barorezeptorstimulatoren sind neue implantierbare Geräte, ähnlich einem Herzschrittmacher, die den karotidalen Barorezeptorenreflex beeinflussen. Hierdurch werden die Sympathikusaktivität reduziert und das Renin-Angiotensin-Aldosteron-System gehemmt. Bei Patienten mit therapieresistenter primärer arterieller Hypertonie führt die permanente Stimulation des Barorezeptorenreflexes zu einer Blutdruckreduktion und damit zu einem kardialen „remodelling“. Intraoperativ muss für die wirkungsvolle Platzierung der Stimulationselektroden an der Karotisbifurkation der Barorezeptorenreflex mehrfach ausgelöst werden. Die gewöhnlich genutzten Anästhetika wie Propofol oder Inhalationsanästhetika dämpfen oder hemmen allerdings die Reflexauslösung. Für die erfolgreiche Implantation sind daher ein spezielles anästhesiologisches und pharmakologisches Management erforderlich.

Abstract

Baroreceptor stimulators are novel implantable devices that activate the carotid baroreceptor reflex. This results in a decrease in activity of the sympathetic nervous system and inhibition of the renin-angiotensin-aldosterone system. In patients with drug-resistant hypertension, permanent electrical activation of the baroreceptor reflex results in blood pressure reduction and cardiac remodeling. For correct intraoperative electrode placement at the carotid bifurcation, the baroreceptor reflex needs to be activated several times. Many common anesthetic agents, such as inhalation anesthetics and propofol dampen or inhibit the baroreceptor reflex and complicate or even prevent successful placement. Therefore, a specific anesthesia and pharmacological management is necessary to ensure successful implantation of baroreceptor reflex stimulators.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    T. Werner, L. Lebar, S. Wittmann, B.M. Graf & Y.A. Zausig

  2. Klinik für Herz-, Thorax und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland

    A. Keyser

  3. Klinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Deutschland

    M. Fischer

  4. Klinik für Herz- und Gefäßchirurgie, Universitätsspital Bern, Bern, Schweiz

    J. Schmidli

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Correspondence to T. Werner.

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T. Werner, L. Lebar, S. Wittmann, A. Keyser, M. Fischer, J. Schmidli, B.M. Graf und Y.A. Zausig geben an, dass keine Interessenkonflikte bestehen.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Werner, T., Lebar, L., Wittmann, S. et al. Anästhesiologisches Management bei Implantation von Barorezeptorstimulatoren. Anaesthesist 64, 683–688 (2015). https://doi.org/10.1007/s00101-015-0061-3

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  • DOI: https://doi.org/10.1007/s00101-015-0061-3

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