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Propofol – Abhängigkeitspotenzial und forensische Relevanz

Propofol—dependence potential and forensic relevance

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Zusammenfassung

Propofol ist ein weltweit sehr häufig eingesetztes Hypnotikum, das neben seiner Eignung für den medizinischen Einsatz auch ein Abhängigkeitspotenzial aufweist. Spätestens seit dem propofolassoziierten Tod des Sängers Michael Jackson ist die Substanz auch der breiten Öffentlichkeit bekannt. Besonders häufig ist der Missbrauch bei Medizinern und medizinischem Fachpersonal. Aufgrund des engen Fensters zwischen den gewünschten Effekten und einer potenziell lebensbedrohlichen Intoxikation ist der missbräuchliche Konsum von Propofol jedoch auch für Mediziner äußerst riskant. Die hohe Letalitätsrate, die innerhalb des ersten Jahres nach Beginn der Abhängigkeit beobachtet wird, verdeutlicht das Risiko, das mit dieser Suchterkrankung einhergeht. Entsprechend ist es umso wichtiger, dass ein solcher Missbrauch frühzeitig erkannt wird. Der Nachweis eines chronischen Propofolmissbrauchs kann mithilfe einer validen Haaranalytik erfolgen.

Abstract

Propofol is a rapidly acting hypnotic agent that is widely used for induction and maintenance of general anesthesia but also for endoscopic and pediatric sedation. Besides its medical application in a clinical setting, propofol is also misused, particularly by healthcare professionals. At least since the propofol-associated death of the performer Michael Jackson, the substance is also known to the general public; however, propofol has a narrow therapeutic range between the desired effects and potentially fatal toxicity, making abuse of the drug extremely dangerous even for experienced physicians. The high mortality rate documented in the first year of substance misuse underlines the risk associated with this addictive disorder. Consequently, early recognition of potential propofol misuse is critical. To confirm such a chronic propofol misuse, a valid hair analysis can be carried out.

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Authors and Affiliations

  1. Institut für Rechtsmedizin, Universität Bonn, Stiftsplatz 12, 53111, Bonn, Deutschland

    A. Maas & B. Madea

  2. Klinik für Anästhesiologie, Intensiv‑, Palliativ- und Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland

    D. Lohr

  3. Abteilung für Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland

    C. Maier

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  4. B. Madea
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Correspondence to A. Maas.

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A. Maas, D. Lohr, C. Maier und B. Madea geben an, dass kein Interessenkonflikt besteht.

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Additional information

Redaktion

B. Madea, Bonn

CME-Fragebogen

CME-Fragebogen

Propofol gilt allgemein als leicht steuerbares Medikament. Dabei kann auch die Wiederherstellung der Fahrtauglichkeit nach einer Propofolsedierung bei gesunden Probanden abgeschätzt werden. Nach welchem Zeitraum kann nach einem einmaligen Bolus von bis zu 80 mg frühestens von einer wiederhergestellten Fahrtauglichkeit ausgegangen werden?

Nach ca. 30 min

Nach etwa 45 min

Nach etwa 1 h

Nach ca. 90 min

Nach etwa 2 h

Welche Substanz kann als Antidot für Propofol eingesetzt werden?

Flumazenil

Naloxon

Phentolamin

Atropin

Aktuell kein Antidot bekannt

Welche psychotropen Effekte von Propofol erklären überwiegend das Abhängigkeitspotenzial?

Halluzinationen

Ausgeprägte Euphorie

Entspannung

Antidepressive Wirkung

Sexuelle Enthemmung

Eine Nebenwirkung von Propofol ist das Absinken des systemischen arteriellen Blutdrucks. In Abhängigkeit von Alter, Volumenstatus und Komorbiditäten kann es dabei auch zur starken Kreislaufdepression kommen. Um wieviel Prozent sinkt der systemische arterielle Blutdruck in Abhängigkeit von der Dosis in der Regel am ehesten?

10–25 %

25–40 %

30–35 %

35–45 %

40–50 %

Welche lebensbedrohliche Komplikation kann nach längerer Propofolanwendung auftreten?

Malignes neuroleptisches Syndrom (MNS)

Propofolinfusionssyndrom (PRIS)

Hyperkinetisches Herzsyndrom (HKHS)

Hämolytisch-urämisches Syndrom (HUS)

Hirnorganisches Psychosyndrom (HOPS)

Wie wird Propofol verabreicht, um die gewünschten anästhesierenden bzw. sedierenden Wirkungen zu erreichen?

Intravenös in einer Sojaölemulsion

Intramuskulär in einer Polysorbatlösung

Intraperitoneal in einer Povidonsuspension

Peroral mit Siliziumdioxidkristallen

Rektal mit Natriumacetatglasur

Wie hoch ist die Sterblichkeitsrate bei Propofolmissbrauch innerhalb des ersten Jahres nach Beginn der Abhängigkeit?

Circa 1–3 %

Circa 5–10 %

Circa 10–20 %

Circa 15–35 %

Circa 50–70 %

Was zählt zu den häufigsten Todesursachen bei einem missbräuchlichen Propofolkonsum?

Atemstillstand

Hypertension

Hyperthermie

Leberzirrhose

Hyponatriämie

Welche analytischen Verfahren werden in der Regel zum Nachweis einer Propofolaufnahme angewandt?

Immunhistochemische Verfahren

Chromatographisch-massenspektrometrische Verfahren

Atomabsorptionsspektroskopische Verfahren

Infrarotphotometrische Verfahren

Dünnschichtchromatographische Verfahren

Welche Matrix wird zum Nachweis eines chronischen Propofolmissbrauchs bevorzugt herangezogen?

Blut

Urin

Speichel

Haare

Fingernägel

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Maas, A., Lohr, D., Maier, C. et al. Propofol – Abhängigkeitspotenzial und forensische Relevanz. Rechtsmedizin 28, 453–467 (2018). https://doi.org/10.1007/s00194-018-0263-5

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  • DOI: https://doi.org/10.1007/s00194-018-0263-5

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