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Neue Aspekte der perioperativen Organprotektion

New aspects of perioperative organ protection

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Zusammenfassung

Hintergrund

Akut auftretende Organschädigungen tragen im perioperativen Kontext signifikant zu Morbidität und Mortalität bei.

Ziel der Arbeit

Es sollen Möglichkeiten skizziert werden, wie perioperative Organschäden präventiv und proaktiv durch die Beeinflussung des „high mobility group box 1 protein (HMGB1) signaling“ vermieden und verringert werden können.

Material und Methoden

Es wurde eine MEDLINE-Suche im Bereich der klinischen und der Grundlagenforschung durchgeführt. Die Darstellung grundlegender Mechanismen perioperativer Organschäden und die Diskussion der Bedeutung von HMGB1 in der Prävention und Therapie mithilfe medikamentöser und nichtmedikamentöser Intervention stehen im Mittelpunkt der Betrachtung.

Ergebnisse

In der Pathogenese von septisch und aseptisch bedingten Organschäden ist HMGB1 ein zentrales Element. „Remote ischemic preconditioning“ (RIPC) und Dexmedetomidin sind hocheffektive Möglichkeiten, um Organschäden abzumildern resp. zu vermeiden.

Schlussfolgerung

Sowohl bei Ischämie-Reperfusionsschäden als auch bei inflammationsbedingten Organschäden bieten RIPC und Dexmedetomidin protektive Eigenschaften, die u. a. HMGB1-vermittelt sind. Hierdurch lassen sich Nieren, Herz, Lungen, Leber und Gehirn wirkungsvoll schützen. Die Anwendung dieser Konzepte sollte im klinischen Alltag Beachtung finden.

Abstract

Background

Acutely occurring organ damage significantly contributes to morbidity and mortality in the perioperative context.

Objective

This article highlights new clinical perspectives on how perioperative organ damage can be prevented and ameliorated by influencing the high mobility group box 1 protein (HMGB1) signaling.

Material and methods

A MEDLINE search was performed in the fields of clinical and basic research. The presentation of basic mechanisms of perioperative organ damage and the discussion of the importance of HMGB1 in prevention and treatment by pharmaceutical and nonpharmaceutical interventions are the focus of the review.

Results

The HMGB1 is a central element in the pathogenesis of septic and aseptic inflammation-induced organ damage. Remote ischemic preconditioning (RIPC) and dexmedetomidine are highly effective approaches to mitigate or prevent organ damage.

Conclusion

The RIPC and dexmedetomidine offer protective properties in ischemia-reperfusion injury as well as in inflammation-related organ damage, which are mediated by HMGB1, among others. This effectively protects the kidneys, heart, lungs, liver and brain. The application of these concepts should be considered in routine clinical practice.

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Danksagung

Die Autoren danken Nina Knubel für die Hilfe beim Erstellen der Abbildungen.

Förderung

Diese Arbeit wurde unterstützt von der Deutschen Forschungsgemeinschaft (DFG RO 4537/5‑1 und ZA 428/18-1).

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Authors and Affiliations

  1. Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland

    Martin Lehmann,  Alexander Zarbock &  Jan Rossaint

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  1. Martin Lehmann
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  2. Alexander Zarbock
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  3. Jan Rossaint
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Correspondence to Jan Rossaint.

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M. Lehmann, A. Zarbock und J. Rossaint geben an, dass kein Interessenkonflikt besteht.

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

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Lehmann, M., Zarbock, A. & Rossaint, J. Neue Aspekte der perioperativen Organprotektion. Anaesthesiologie 71, 741–749 (2022). https://doi.org/10.1007/s00101-022-01197-6

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