Natürliche und synthetische Katecholamine

Zusammenfassung

Katecholamine sind aus dem anästhesiologischen Alltag nicht mehr wegzudenken. Ob nun während einer Sectio bei gesunden jungen Frauen, im Operationssaal, bei multimorbiden Patienten auf Intensivstation oder im Notfalleinsatz auf der Straße: Das notwendige Basiswissen, um Katecholamine korrekt anzuwenden, ist entscheidend für das Outcome unserer Patienten und steht im Fokus dieses Beitrags.

Abstract

Vasopressors (synthetic catecholamines) play an important role in the management of hemodynamics and are being used by perioperative anaesthesiologists and intensive care physicians around the world on a daily basis. However, vasopressors require a cautious use and may inflict serious harm if applied in an inappropriate manner or in the wrong situation. Whether it is during a caesarean section in healthy young women, in multimorbid patients in the intensive care unit or in in the preclinical setting: Knowing the basics of pharmacodynamics and -kinetics of the commonly used vasopressors is crucial for the outcome of patients and is the focus of this article.

Kernaussagen

• Katecholamine sind hochpotente Medikamente zur Modulation des Herz-Kreislauf-Systems.

• Die sichere Anwendung von Katecholaminen erfordert die detaillierte Kenntnis um ihre physiologische Wirkweise, Indikationen und Kontraindikationen.

• Bei Katecholaminen mit einer ausgeprägten β-adrenergen Wirkung (z. B. Adrenalin und Dobutamin) muss die Erhöhung des myokardialen Sauerstoffverbrauchs mitbedacht werden. Bei Patienten mit vorbestehender koronararterieller Herzerkrankung ist die Gefahr einer myokardialen Ischämie zu beachten.

• Indirekt wirksame synthetische Katecholamine (indirekte Sympathomimetika) sind aufgrund der möglichen Bolusgabe und ihrer mittleren Wirkdauer eine elegante Methode zur kurzfristigen Erhöhung des Herzzeitvolumens und des systemvaskulären Widerstands im perioperativen Kontext.

• Eine längerfristige Katecholamin-Therapie beim kritisch kranken Intensivpatienten sollte als kontinuierliche Infusionstherapie mit Noradrenalin, Adrenalin oder Dobutamin unter kontinuierlicher Blutdruckkontrolle (arterielle Druckmessung) durchgeführt werden.

Schlüsselwörter

Katecholamine - natürlich - synthetisch - Adrenalin - Noradrenalin

Key words

catecholamines - natural - synthetic - epinephrine - norepinephrine

Publication History

Article published online:
29 June 2021

• Literatur

• 1 Riessen R, Tschritter O, Janssens U. et al. [Catecholamines: pro and contra]. Med Klin Intensivmed Notfmed 2016; 111: 37-46
• 2 Asfar P, Meziani F, Hamel JF. et al. High versus low blood-pressure target in patients with septic shock. N Engl J Med 2014; 370: 1583-1593
• 3 Tank AW, Lee Wong D. Peripheral and central effects of circulating catecholamines. Compr Physiol 2015; 5: 1-15
• 4 Flatmark T. Catecholamine biosynthesis and physiological regulation in neuroendocrine cells. Acta Physiol Scand 2000; 168: 1-17
• 5 Goldstein M, Fuxe K, Hokfelt T. Characterization and tissue localization of catecholamine synthesizing enzymes. Pharmacol Rev 1972; 24: 293-309
• 6 Kaumann AJ, Lemoine H. Beta 2-adrenoceptor-mediated positive inotropic effect of adrenaline in human ventricular myocardium. Quantitative discrepancies with binding and adenylate cyclase stimulation. Naunyn-Schmiedebergs Arch Pharmacol 1987; 335: 403-411
• 7 Dahmani S, Brasher C, Stany I. et al. Premedication with clonidine is superior to benzodiazepines. A meta analysis of published studies. Acta Anaesthesiol Scand 2010; 54: 397-402
• 8 Molinoff PB. Alpha- and beta-adrenergic receptor subtypes properties, distribution and regulation. Drugs 1984; 28 (Suppl. 02) 1-15
• 9 Kopin IJ. Monoamine oxidase and catecholamine metabolism. J Neural Transm Suppl 1994; 41: 57-67
• 10 Rhodes A, Evans LE, Alhazzani W. et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med 2017; 45: 486-552
• 11 Ponikowski P, Voors AA, Anker SD. et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016; 18: 891-975
• 12 Soar J, Nolan JP, Bottiger BW. et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation 2015; 95: 100-147
• 13 Giraud GD, MacCannell KL. Decreased nutrient blood flow during dopamine- and epinephrine-induced intestinal vasodilation. J Pharmacol Exp Ther 1984; 230: 214-220
• 14 Osborn D, Evans N, Kluckow M. Randomized trial of dobutamine versus dopamine in preterm infants with low systemic blood flow. J Pediatr 2002; 140: 183-191
• 15 Ramaswamy KN, Singhi S, Jayashree M. et al. Double-blind randomized clinical trial comparing dopamine and epinephrine in pediatric fluid-refractory hypotensive septic shock. Pediatr Crit Care Med 2016; 17: e502-e512
• 16 Ventura AM, Shieh HH, Bousso A. et al. Double-blind prospective randomized controlled trial of dopamine versus epinephrine as first-line vasoactive drugs in pediatric septic shock. Crit Care Med 2015; 43: 2292-2302
• 17 Baske K, Saini SS, Dutta S. et al. Epinephrine versus dopamine in neonatal septic shock: a double-blind randomized controlled trial. Eur J Pediatr 2018; 177: 1335-1342
• 18 Dunser MW, Hasibeder WR. Sympathetic overstimulation during critical illness: adverse effects of adrenergic stress. J Intensive Care Med 2009; 24: 293-316
• 19 Starke K, Endo T, Taube HD. Relative pre- and postsynaptic potencies of alpha-adrenoceptor agonists in the rabbit pulmonary artery. Naunyn-Schmiedebergs Arch Pharmacol 1975; 291: 55-78
• 20 Richardson PD, Granger DN, Kvietys PR. Effects of norepinephrine, vasopressin, isoproterenol, and histamine on blood flow, oxygen uptake, and capillary filtration coefficient in the colon of the anesthetized dog. Gastroenterology 1980; 78: 1537-1544
• 21 Vadas P, Perelman B. Effect of epinephrine on platelet-activating factor-stimulated human vascular smooth muscle cells. J Allergy Clin Immunol 2012; 129: 1329-1333
• 22 Eisenhofer G, Kopin IJ, Goldstein DS. Catecholamine metabolism: a contemporary view with implications for physiology and medicine. Pharmacol Rev 2004; 56: 331-349
• 23 Learmonth DA, Kiss LE, Soares-da-Silva P. The chemistry of catechol-O-methyltransferase inhibitors. Int Rev Neurobiol 2010; 95: 119-162
• 24 Moran DH, Perillo M, LaPorta RF. et al. Phenylephrine in the prevention of hypotension following spinal anesthesia for cesarean delivery. J Clin Anesth 1991; 3: 301-305
• 25 Cloutier MM, Dixon AE, Krishnan JA. et al. Managing Asthma in Adolescents and Adults: 2020 Asthma Guideline Update From the National Asthma Education and Prevention Program. JAMA 2020; 324: 2301-2317
• 26 Aniset L, Konrad C, Schley M. [Ephedrine as alternative to Akrinor in regional obstetric anesthesia]. Anaesthesist 2006; 55: 784-790
• 27 Radstrom M, Bengtsson J, Ederberg S. et al. Effects of ephedrine on oxygen consumption and cardiac output. Acta Anaesthesiol Scand 1995; 39: 1084-1087
• 28 Hartmann C, Radermacher P, Wepler M. et al. Non-hemodynamic effects of catecholamines. Shock 2017; 48: 390-400
• 29 Lanza F, Cazenave JP, Beretz A. et al. Potentiation by adrenaline of human platelet activation and the inhibition by the alpha-adrenergic antagonist nicergoline of platelet adhesion, secretion and aggregation. Agents Actions 1986; 18: 586-595