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Perioperative Strategien zur Regulierung des Sympathikotonus

Strategies for perioperative sympatho-modulation

  • Leitthema
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Zusammenfassung

Obwohl für verschiedene therapeutische Konzepte zur Verminderung der kardialen perioperativen Morbidität und Mortalität zunehmend Evidenz vorliegt, bleibt die tatsächliche Umsetzung solcher Konzepte im klinischen Alltag oft aus. Zwar ist einem großen Teil der klinisch tätigen Ärzte die wachsende Literatur bekannt; dieses Wissen wird aber nur in einem Teil der Fälle angewendet, selbst wenn allgemein akzeptierte Indikationen bestehen. Die vorliegende Übersichtsarbeit hat deshalb zum Ziel, die Gründe für die mangelnde Umsetzung aufzuzeigen und nochmals die wesentlichen Grundlagen sowie die klinische Bedeutung einzelner Strategien einschließlich des α2-Agonismus, der β-adrenergen Blockade und der Regionalanästhesien zusammenzufassen. Dies insbesondere im Hinblick auf die klinische Anwendung dieser Konzepte in einem allgemeinanästhesiologischen Umfeld. Zudem wird ein Ausblick in die auf „gene profiling“ basierende individualisierte Pharmakotherapie der perioperativen Medizin von morgen gegeben.

Abstract

Despite the growing evidence for the efficacy of different sympatho-modulatory therapies to lower perioperative cardiac morbidity and mortality, such therapeutic strategies are rather infrequently used in daily clinical practice. Most physicians involved in perioperative medicine are aware of the increasing literature related to this topic, but only few comply with current clinical practice guidelines even in the absence of contraindications. This review discusses possible explanations for this reluctance and again summarizes the basic and clinical principles of current sympatho-modulatory therapies including α2-agonism, β-adrenergic antagonism, and regional anesthetic techniques in modern anesthetic practice. In addition, the emerging perioperative concept of a patient-tailored individualized pharmacotherapy based on “gene profiling”, particularly the adrenergic polymorphisms, is discussed.

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Danksagung

Teile der vorliegenden Arbeit wurden durch Beiträge des Schweizerischen Nationalfonds (3200–063417.00 und 3200130–1039880/1), der Schweizerischen Herzstiftung und der Schweizerischen Gesellschaft für Anästhesiologie und Reanimation finanziell unterstützt. Die Autoren danken Frau Dr. med. Ursula Dittli und Frau Dr. phil. Eliana Lucchinetti für die Durchsicht und Korrektur des Manuskripts.

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  1. Institut für Anästhesiologie, Universitätsspital Zürich

    J. Wacker, T. Pasch & M. Zaugg

  2. Institut für Pharmakologie und Toxikologie, Universität Zürich

    M. C. Schaub & M. Zaugg

  3. Institut für Anästhesiologie und Institut für Pharmakologie und Toxikologie, Universitätsspital Zürich, Rämistraße 100, 8091, Zürich, Schweiz

    M. Zaugg

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  1. J. Wacker
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Wacker, J., Pasch, T., Schaub, M.C. et al. Perioperative Strategien zur Regulierung des Sympathikotonus. Anaesthesist 54, 303–318 (2005). https://doi.org/10.1007/s00101-005-0826-1

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