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Perioperative medikamentöse Kreislaufunterstützung in der täglichen Routine

Perioperative pharmacological circulatory support in daily clinical routine

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Zusammenfassung

Perioperative hypotensive Phasen sind mit der Zunahme von postoperativen Komplikationen und Organschäden assoziiert. Während noch vor einigen Jahren die hämodynamische Stabilisierung in erster Linie durch Volumengaben geprägt war, haben in letzter Zeit der Einsatz und auch die Dosierung kardiovaskulär aktiver Substanzen deutlich zugenommen. Wie für die intravasale Volumentherapie gilt auch für die Therapie mithilfe Herz-Kreislauf-wirksamer Substanzen, dass diese aufgrund ihrer geringen therapeutischen Breite Nebenwirkungen haben. Im vorliegenden Übersichtsbeitrag werden konkrete Indikationen der einzelnen kardiovaskulär aktiven Wirkstoffe mit den jeweiligen Vor- und Nachteilen diskutiert. Besonderer Fokus liegt auf der Fragestellung der Applikationsform: zentraler Venenkatheter vs. periphere Venenverweilkanüle. Die Autoren kommen zu dem Schluss, dass sich nicht die Frage stellt, ob es prinzipiell erlaubt ist, Herz-Kreislauf wirksame Medikamente periphervenös zu applizieren, sondern vielmehr, was dabei zu beachten ist. Der Beitrag gibt entsprechende Empfehlungen.

Abstract

Perioperative phases of hypotension are associated with an increase in postoperative complications and organ damage. Whereas some years ago hemodynamic stabilization was primarily carried out by volume supplementation, in recent years the use and dosing of cardiovascular-active substances has significantly increased. But like intravascular volume therapy, also substances with a cardiovascular effect have therapeutic margins, and thus, potential side effects. This review article discusses indications for each cardiovascular-active agent, weighing up advantages and disadvantages. Special attention is paid to the question how to administrate them: central venous catheter vs. peripheral indwelling venous cannula. The authors come to the conclusion that it is not a question of whether it is principally allowed to apply cardiovascular-active drugs via peripheral veins but more importantly, what should be taken into consideration if a peripheral venous access is used. This article provides concise recommendations.

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  1. Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland

    A. Haas,  T. Schürholz &  D. A. Reuter

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Correspondence to D. A. Reuter.

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A. Haas, T. Schürholz und D.A. Reuter geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Haas, A., Schürholz, T. & Reuter, D.A. Perioperative medikamentöse Kreislaufunterstützung in der täglichen Routine. Anaesthesist 69, 781–792 (2020). https://doi.org/10.1007/s00101-020-00803-9

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