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Schmerztherapie bei Alters- und Risikopatienten

  • I. Bowdler
  • K. A. Lehmann

Zusammenfassung

Dank besserer Lebensbedingungen und medizinischer Fortschritte nimmt in den Industrieländern der prozentuale Anteil der Menschen, die über 65 Jahre alt sind, ständig zu — in der Bundesrepublik Deutschland sind es zur Zeit fast 9 Mio. Obwohl das chronologische dem biologischen Alter nicht immer entspricht, verdeutlicht diese Zahl doch, wie altersbedingte physiologische Veränderungen, die ohne Zweifel die Therapie beeinflussen, für die klinische Praxis an Bedeutung gewinnen müssen. Neben dieser Gruppe haben wir in zunehmendem Maße aber auch multimorbide Patienten jüngeren Alters zu behandeln, bei denen krankheitsbedingte pathophysiologische Störungen in den Vordergrund treten.

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Literatur

  1. 1.
    Aitkenhead AR, Vater M, Achola K, Cooper CMS, Smith G (1984) Pharmacokinetics of single-dose i.v. morphine in normal volunteers and patients with end-stage renal failure. Br J Anaesth 56: 813–819PubMedCrossRefGoogle Scholar
  2. 2.
    Alexander JI, Hill RG (1987) Postoperative Pain Control. Blackwell Scientific Publications, OxfordGoogle Scholar
  3. 3.
    Arunsalam J, Davenport HT, Painter S, Jones JG (1983) Ventilatory response to morphine in young and old subjects. Anaesthesia 38: 529–533Google Scholar
  4. 4.
    Bach B, Hansen JM, Kampmann JP, Rasmussen SN, Skovsted L (1981) Disposition of antipyrine and phenytoin correlated with age and liver volume in man. Clin Pharmacokinet 6: 389–396PubMedCrossRefGoogle Scholar
  5. 5.
    Ball M, McQuay HJ, Moore RA, Allen MC, Fisher A, Sear J (1985) Renal failure and the use of morphine in intensive care. Lancet 1: 784–786PubMedCrossRefGoogle Scholar
  6. 6.
    Baskin SI, Smith L, Hoey LA, Levy PI, Goldfarb AH (1981) Age-associated changes of responses to acetylsalicylic acid. Pain 11: 1–8PubMedCrossRefGoogle Scholar
  7. 7.
    Bellville JW, Forrest WH, Miller E, Brown BW (1971) Influence of age on pain relief from analgesics. JAMA 217: 1835–1841PubMedCrossRefGoogle Scholar
  8. 8.
    Bender AD (1968) Effect of age on intestinal absorption: Implication for drug absorption in the elderly. J Am Geriatr Soc 16: 1331–1339PubMedGoogle Scholar
  9. 9.
    Bergener M, Hesse C (1968) Pharmakotherapie im Alter unter besonderer Berücksichtigung der Psychopharmakotherapie. Krankenhausarzt 59: 123–128Google Scholar
  10. 10.
    Berkowitz BA, Ngai SH, Yang JC, Hempstead J, Spector S (1975) The disposition of morphine in surgical patients. Clin Pharmacol Ther 17: 629–635PubMedGoogle Scholar
  11. 11.
    Blackshear J, Davidman L, Stillman MT (1983) Identification of risk for renal insufficiency from nonsteroidal antiinflammatory drugs. Arch Intern Med 143: 1130–1134PubMedCrossRefGoogle Scholar
  12. 12.
    Boreus LO, Odar-Cederlöf I, Bondesson U, Holmberg L, Heyner L (1986) Elimination of meperidine and its metabolites in old compared to young patients. Adv Pain Res Ther 8: 167–169Google Scholar
  13. 13.
    Bower S (1982) Plasma protein binding of fentanyl: the effect of hyperlipoproteinaemia and chronic renal failure. J Pharm Pharmacol 34: 102–106PubMedCrossRefGoogle Scholar
  14. 14.
    Bromage PR (1962) Spread of analgesic solutions in the epidural space and their site of action: a statistical study. Br J Anaesth 34: 161–178PubMedCrossRefGoogle Scholar
  15. 15.
    Bromage PR (1969) Ageing and epidural dose requirements. Br J Anesth 41: 1016–1022CrossRefGoogle Scholar
  16. 16.
    Burn JM, Guyer PB, Langdon L (1973) The spread of solutions injected into the epidural space. A study using epidurograms in patients with the lumbosciatic syndrome. Br J Anaesth 45: 338–345Google Scholar
  17. 17.
    Carmichael J, Shankel SW (1985) Effects of non-steroidal anti-inflammatory drugs on prostaglandins and renal function. Am J Med 78: 992–1000PubMedCrossRefGoogle Scholar
  18. 18.
    Castleden CM, George CF, Marcer D, Hallett C (1977) Increased sensitivity to nitrazepam in old age. Br Med J 1: 10–12PubMedCrossRefGoogle Scholar
  19. 19.
    Chan K, Kendall MJ, Mitchard M, Wells WDE, Vickers MD (1975) The effects of ageing on plasma pethidine concentrations. Br J Clin Pharmacol 2: 297–302PubMedCrossRefGoogle Scholar
  20. 20.
    Chauvin M, Lebrault C, Levron JC, Duvaldestin P (1987) Pharmacokinetics of alfentanil in chronic renal failure. Anesth Analg 66: 53–56PubMedCrossRefGoogle Scholar
  21. 21.
    Chauvin M, Bonnet F, Montembault C, Levron JC, Viars P (1986) The influence of hepatic plasma flow on alfentanil plasma concentration plateaus achieved with an infusion model in humans: measurements of alfentanil hepatic extraction coefficient. Anesth Analg 65: 999–1003PubMedCrossRefGoogle Scholar
  22. 22.
    Chauvin M, Sandouk P, Scherrmann JM, Farinotti R, Strumza P, Duvaldestin P (1987) Morphine pharmacokinetics in renal failure. Anesthesiology 66: 327–331PubMedCrossRefGoogle Scholar
  23. 23.
    Clive DM, Stoff JS (1984) Renal syndromes associated with nonsteroidal antiinflammatory drugs. N Engl J Med 310: 563–572PubMedCrossRefGoogle Scholar
  24. 24.
    Corall IM, Moore RA, Strunin L (1980) Plasma concentrations of fentanyl in normal surgical patients and those with severe renal and hepatic disease. Br J Anaesth 52:1O1PGoogle Scholar
  25. 25.
    Corsellis JAN (1976) Ageing and the dementias. In: Blackwood W, Corsellis JAN (eds) Greenfields Neuropathology. Arnold, London, pp 769–848Google Scholar
  26. 26.
    Cottrell L (1940) Histologic variations with age in apparently normal peripheral nerve trunks. Arch Neurol Psychiat 43: 1138–1151CrossRefGoogle Scholar
  27. 27.
    Crooks J, O’Malley K, Stevenson IH (1976) Pharmacokinetics in the elderly. Clin Pharmacokinet 1: 280–296PubMedCrossRefGoogle Scholar
  28. 28.
    David E (1980) Die Habituation des Schmerzes im Alter. Gerontologie 13: 189–194Google Scholar
  29. 29.
    Davison AN (1978) Biochemial aspects of the ageing brain. Age Ageing 7 (Suppl): 4–11CrossRefGoogle Scholar
  30. 30.
    Divoll M, Greenblatt DJ, Ameer B, Abernethy DR (1982) Effect of food on acetaminophen absorption in young and elderly subjects. J Clin Pharmacol 22: 571–276PubMedCrossRefGoogle Scholar
  31. 31.
    Dodson ME (1985) The Management of Postoperative Pain. Edward Arnold, BaltimoreGoogle Scholar
  32. 32.
    Don HF, Dieppa RA, Taylor P (1975) Narcotic analgesics in anuric patients. Anesthesiology 42: 745–747PubMedCrossRefGoogle Scholar
  33. 33.
    Donovan BD (1983) Patient attitudes to postoperative pain relief. Anaesth Intensive Care 11: 125–129PubMedGoogle Scholar
  34. 34.
    Dunn MJ (1984) Nonsteroidal antiinflammatory drugs and renal function. Annu Rev Med 35: 411–428PubMedCrossRefGoogle Scholar
  35. 35.
    Ferrier C, Marty J, Bouffard Y, Haberer P, Levron JC, Duvaldestin P (1985) Alfentanil pharmacokinetics in patients with cirrhosis. Anesthesiology 62: 480–484PubMedCrossRefGoogle Scholar
  36. 36.
    Finucane BT, Hammonds WD, Welch MB (1987) Influence of age on vascular absorption of lidocaine from the epidural space. Anesth Analg 66: 843–846PubMedCrossRefGoogle Scholar
  37. 37.
    Freund PR, Bowdle TA, Slattery JT, Haschke RH, Ward RJ (1982) Comparative lidocaine pharmacokinetics during caudal anesthesia in young and geriatric patients. Anesthesiology 57: A212CrossRefGoogle Scholar
  38. 38.
    Fritz KW, Lüllwitz E, Seitz W, Schindler E (1986) Spinalanästhesien urologischer Patienten. Klinikarzt 15: 550–554Google Scholar
  39. 39.
    Greenblatt DJ, Abernethy DR, Divoll M, Ochs HR, Shader RI (1983) Antipyretic analgesic drugs as models for studies of drug disposition in old age. Am J Med 75 (A5): 127–132PubMedCrossRefGoogle Scholar
  40. 40.
    Gustafsson LL, Schildt B, Jacobson K (1982) Adverse effects of extradural and intrathecal opiates: Report of a nationwide survey in Sweden. Br J Anaesth 54: 479–488Google Scholar
  41. 41.
    Haberer JP, Schoeffler P, Couderc E, Duvaldestin P (1982) Fentanyl pharmacokinetics in anaesthetized patients with cirrhosis. Br J Anaesth 54: 1267–1270PubMedCrossRefGoogle Scholar
  42. 42.
    Hansen G, Drablos PA, Steinert R (1977) Pulmonary complications, ventilation and blood gases after upper abdominal surgery. Acta Anaesthesiol Scand 21: 211–215PubMedCrossRefGoogle Scholar
  43. 43.
    Harkins SW, Chapman CR (1976) Detection and decision factors in pain perception in young and elderly men. Pain 2: 253–264PubMedCrossRefGoogle Scholar
  44. 44.
    Herman RJ, McAllister CB, Branch RA, Wilkinson GR (1985) Effects of age on meperidine disposition. Clin Pharmacol Ther 37: 19–24PubMedCrossRefGoogle Scholar
  45. 45.
    Holmberg L, Odar-Cederlof I, Boreus LO, Heyner L, Ehrnebo M (1982) Comparative disposition of pethidine and norpethidine in old and young patients. Eur J Clin Pharmacol 22: 175–179PubMedCrossRefGoogle Scholar
  46. 46.
    Hunt TE (1976) Management of chronic non-rheumatic pain in the elderly. J Am Geriatr Soc 24: 402–406PubMedGoogle Scholar
  47. 47.
    Hurwitz N (1969) Predisposing factors in adverse reactions to drugs. Br Med J 1: 536–539PubMedCrossRefGoogle Scholar
  48. 48.
    Jick H (1982) Adverse effects of acetylsalicylic acid. In: Barnett HJM, Hirsh J, Mustard JF (eds) Acetylsalicylic Acid: New Uses for an Old Drug. Raven Press, New York, pp 239–250Google Scholar
  49. 49.
    Jori A, Di Salle E, Quadri A (1972) Rate of aminopyrine disappearance in young and aged humans. Pharmacology 8: 273–279PubMedCrossRefGoogle Scholar
  50. 50.
    Kaiko RF (1980) Age and morphine analgesia in cancer patients with postoperative pain. Clin Pharmacol Ther 28: 823–826PubMedCrossRefGoogle Scholar
  51. 51.
    Kaiko RF, Wallenstein SL, Rogers AG, Grabinski PY, Houde RW (1986) Clinical analgesic studies and sources of variation in analgesic responses to morphine. Adv Pain Res Ther 8: 13–24Google Scholar
  52. 52.
    Kang YG, Uram M, Shiu GK, Bleyaert A, Martin J, Nemoto E, Starzl T (1984) Pharmacokinetics of fentanyl in end-stage liver disease. Anesthesiology 61: A380CrossRefGoogle Scholar
  53. 53.
    Kent AP, Dodson ME, Bower S (1988) The pharmacokinetics of alfentanil in elderly patients. Acta Anaesthesiol Belg 39: 25–33PubMedGoogle Scholar
  54. 54.
    Klotz U, McHorse TS, Wilkinson GR, Schenker S (1974) The effect of cirrhosis on the disposition of meperidine in man. Clin Pharmacol Ther 16: 667–675PubMedGoogle Scholar
  55. 55.
    Lifschitz MD (1983) Renal effects of nonsteroidal anti-inflammatory agents. J Lab Clin Med 102: 313–323PubMedGoogle Scholar
  56. 56.
    Macdonald ET, Macdonald JB (1982) Drug treatment in the elderly. In: Hall MRP (ed) Disease Management in the Elderly, Vol I. John Wiley and Sons, Chicester New York, pp 1–3Google Scholar
  57. 57.
    Macdonald ET, Macdonald JB (1982) Drug treatment in the elderly. In: Hall MRP (ed) Disease Management in the Elderly, Vol I. John Wiley and Sons, Chicester New York, p 41Google Scholar
  58. 58.
    Mather LE, Tucker FT, Pflug AE, Lindop MJ, Wilkerson C (1975) Meperidine kinetics in man. Intravenous injection in surgical patients and volunteers. Clinic Pharmacol Ther 17: 21–30Google Scholar
  59. 59.
    McQuay HJ, Moore A (1984) Be aware of renal function when prescribing morphine. Lancet 2: 384–385Google Scholar
  60. 60.
    McQuay HJ, Moore RA, Bullingham RES (1986) Buprenorphin kinetics. Adv Pain Res Ther 8: 271–278Google Scholar
  61. 61.
    O’Malley K, Crooks J, Duke E, Stevenson IH (1971) Effect of age and sex on human drug metabolism. Br Med J 3: 607–609PubMedCrossRefGoogle Scholar
  62. 62.
    Modig J, Paalzow L (1981) A comparison of epidural morphine and epidural bupivacaine for postoperative pain relief. Acta Anaesthesiol Scand 25: 437–441PubMedCrossRefGoogle Scholar
  63. 63.
    Mostert JW, Evers JL, Hobika GH, Moore RH, Ambrus JL (1971) Cardiorespiratory effects of anaesthesia with morphine or fentanyl in chronic renal failure and cerebral toxicity after morphine. Br J Anaesth 43: 1053–1059PubMedCrossRefGoogle Scholar
  64. 64.
    Nation RL, Triggs EJ, Selig M (1977) Lignocaine pharmacokinetics in cardiac patients and aged subjects. Br J Clin Pharmacol 4: 439–448PubMedCrossRefGoogle Scholar
  65. 65.
    Patwardhan RV, Johnson RF, Hoyumpa A (1981) Normal metabolism of morphine in cirrhosis. Gastroenterology 81: 1006–1011PubMedGoogle Scholar
  66. 66.
    Portenoy RK (1987) Optimal pain control in elderly cancer patients. Geriatrics 42: 33–44PubMedGoogle Scholar
  67. 67.
    Reeves WB Foley RJ, Weinmann EJ (1984) Renal dysfunction from non-steroidal anti-inflammatory drugs. Arch Intern Med 144: 1943–1944PubMedCrossRefGoogle Scholar
  68. 68.
    Reidenberg MM, Levy M, Warner H, Coutinho CB, Schwartz MA, Yu G, Cheripko J (1978) Relationship between diazepam dose, plasma level, age, and central nervous system depression. Clin Pharmacol Ther 23: 371–374PubMedGoogle Scholar
  69. 69.
    Reidenberg MM, Drayer DE (1984) Alteration of drug-protein binding in renal disease. Clin Pharmacokinet 9 (Suppl 1): 18–26PubMedCrossRefGoogle Scholar
  70. 70.
    Richey DP, Bender AD (1977) Pharmacokinetic consequences of ageing. Annu Rev Pharmacol Toxicol 17: 49–65PubMedCrossRefGoogle Scholar
  71. 71.
    Rietbrock I (1982) Elimination and Wirkungsverlust intravenöser Narkotika. In: Lawin P, Götz E, Huth h (Hrsg) Intravenöse Narkose and Langzeitsedierung. Thieme, Stuttgart, S 29–41Google Scholar
  72. 72.
    Richey DP, Bender AD (1977) Pharmacokinetic consequences of aging. Annu Rev Pharmacol Toxicol 17: 49–65PubMedCrossRefGoogle Scholar
  73. 73.
    Roberts MS, Rumble RH, Wanwimolruk S, Thomas D, Brooks PM (1983) Pharmacokinetics of aspirin and salicylate in elderly subjects and in patients with alcoholic liver disease. Eur J Clin Pharmacol 25: 253–261PubMedCrossRefGoogle Scholar
  74. 74.
    Säwe J, Dahlström B, Paalzow L, Rane A (1981) Morphine kinetics in cancer patients. Clin Pharmacol Ther 30: 629–635PubMedCrossRefGoogle Scholar
  75. 75.
    Schmucker P, van Ackern K, Franke N, Noisser H, Militzer H, Peter K, Kreuzer E, Tiirk R (1980) Hämodynamische and respiratorische Effekte von Pentazocin. Untersuchungen an kardio-chirurgischen Patienten. Anaesthesist 29: 475–480Google Scholar
  76. 76.
    Scott LE, Clum GA, Peoples JB (1983) Preoperative predictors of postoperative pain. Pain 15: 283–293PubMedCrossRefGoogle Scholar
  77. 77.
    Scott JC, Stanski DR (1987) Decreased fentanyl and alfentanil dose requirements with age. A simultaneous pharmacokinetic and pharmacodynamic evaluation. J Pharmacol Exp Ther 240: 159–166Google Scholar
  78. 78.
    Sear J, Moore A, Hunniset A, Baldwin D, Allen M, Hand C, McQuay H, Morris P (1985) Morphine kinetics and kidney transplantation: Morphin removal is influenced by renal ischemia. Anesth Analg 64: 1065–1070Google Scholar
  79. 79.
    Sear JW, Bower S, Potter D (1986) Disposition of alfentanil in patients with chronic renal failure. Br J Anaesth 58: 812 PGoogle Scholar
  80. 80.
    Shelly MP, Cory EP, Park GR (1986) Pharmacokinetics of morphine in two children before and after liver transplantation. Br J Anaesth 58: 1218–1223PubMedCrossRefGoogle Scholar
  81. 81.
    Shepherd AMM, Hewick DS, Moreland TA, Stevenson IH (1977) Age as a determinant of sensitivity to warfarin. Br J Clin Pharmacol 4: 315–320PubMedCrossRefGoogle Scholar
  82. 82.
    Sherman ED, Robillard E (1960) Sensitivity to pain in the aged. Can Med Assoc J 83: 944947Google Scholar
  83. 83.
    Singleton MA, Rosen JJ, Fisher DM (1988) Pharmacokinetics of fentanyl in the elderly. Br J Anaesth 60: 619–622PubMedCrossRefGoogle Scholar
  84. 84.
    Stanski DR, Greenblatt DJ, Lowenstein E (1978) Kinetics of intravenous and intramuscular morphine. Clin Pharmacol Ther 29: 52–59Google Scholar
  85. 85.
    Triggs EJ, Nation RL, Long A, Ashley JJ (1975) Pharmacokinetics in the elderly. Eur J Clin Pharmacol 8: 55–62PubMedCrossRefGoogle Scholar
  86. 86.
    Twycross RG, Regnard CFB (1986) Metabolism of narcotics. Br Med J 288: 860Google Scholar
  87. 87.
    Veering BT, Burm AGL, van Kleef JW, Hennis PJ, Spierdijk J (1987) Epidural anesthesia with bupivacaine: effects of age on neural blockade and pharmacokinetics. Anesth Analg 66: 589–593PubMedGoogle Scholar
  88. 88.
    Veering BT, Burm AGL, van Kleef JW, Hennis PJ, Spierdijk J (1987) Spinal anesthesia with glucose-free bupivacaine: effects of age on neural blockade and pharmacokinetics. Anesth Analg 66: 965–970PubMedGoogle Scholar
  89. 89.
    Vestal RF (1982) Pharmacology and aging. J Am Geriatr Soc 30: 191–200PubMedGoogle Scholar
  90. 90.
    Wallace S, Whiting B, Runcie J (1976) Factors affecting drug binding in plasma of elderly patients. Br J Clin Pharmacol 3: 327–330PubMedCrossRefGoogle Scholar
  91. 91.
    Wightman JAK (1968) A prospective survey of the incidence of postoperative pulmonary complications. Br J Surg 55: 85–91PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1990

Authors and Affiliations

  • I. Bowdler
  • K. A. Lehmann

There are no affiliations available

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