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DOI: 10.1055/s-0031-1273411
© Georg Thieme Verlag KG Stuttgart · New York
Einschätzung des Abhängigkeitsrisikos von Propofol
Assessment of the Addictive Risk of PropofolPublication History
Publication Date:
01 August 2011 (online)
![](https://www.thieme-connect.de/media/fdn/201108/lookinside/thumbnails/10.1055-s-0031-1273411-1.jpg)
Zusammenfassung
In einer Befragung von amerikanischem und deutschem medizinischen Personal wurde das Injektions-Hypnotikum Propofol als eines der am häufigsten missbrauchten Anästhetika genannt. Mithilfe einer MEDLINE, EMBASE, Scopus, Cochrane und Internet-Recherche wurden Daten gesucht, die eine Einschätzung des Abhängigkeitsrisikos von Propofol erlauben. Die klinische Einschätzung für Hypnotika erfolgt üblicherweise anhand der Skala nach Griffith und Johnson. Hiernach ist das relative Abhängigkeitsrisiko (Abhängigkeitspotenzial/Toxizität) von Propofol verglichen mit Phenobarbital eher mäßig ausgeprägt. Das Abhängigkeitspotenzial ist etwas geringer als das von Lorazepam und Cannabis (nicht hypnotisches Referendum) und liegt etwa im Bereich dessen von Triazolam oder Zopiclon. Die wenigen bisher publizierten klinischen Fallberichte (n = 8) stammen hauptsächlich aus Deutschland und beschreiben ausgeprägte psychische (Craving, Kontrollverlust, Verhaltenseinengung auf Konsum und Beschaffung) und wenig körperliche Abhängigkeitsmerkmale (Entzugssyndrom, Toleranz). Durchschnittlich waren in den Kasuistiken 4,25 von 6 Abhängigkeitskriterien nach ICD-10 erfüllt. Der Konsum von Propofol ist hauptsächlich auf Mediziner oder medizinnahe Berufe begrenzt. Auf den hiesigen Schwarzmärkten ist Propofol noch nicht angekommen. Ein oraler Konsum scheint nicht vorzukommen oder unattraktiv zu sein. Die Attraktivität der Rauschwirkung (Euphorie/Entspannung) von Propofol über den intravenösen Weg wird vermutlich unterschätzt. In diese Richtung weist die hohe Mortalitätsrate (46,2 %) in den bis heute insgesamt 78 publizierten Fällen zum Propofolkonsum. Forensische Analysen machen in erster Linie akzidentielle Atemstillstände für die Todesfälle verantwortlich. Zusammenfassend kann Propfol als eine primär psychisch abhängig machende Substanz gelten, die charakteristischerweise intravenös von Personen mit medizinischen Berufen konsumiert wird. Aufgrund seines offenbar sehr engen Sicherheitsraums zwischen Vergnügen und Tod besitzt Propofol eine außerordentliche Gefährlichkeit, welche in der Skala von Griffith und Johnson leider nur unzureichend abgebildet werden kann.
Abstract
In a survey of American and German medical personnel, the injectable hypnotic propofol was identified as one of the most frequently abused anaesthetics. With the help of MEDLINE, EMBASE, Scopus, Cochrane and internet search, data were sought that permit an assessment of propofol’s risk of addiction. The clinical evaluation for hypnotics can usually be made with the scale of Griffith and Johnson. Thereafter, the relative risk of addiction (dependence potential/toxicity) of propofol is rather moderate if compared to phenobarbital. Its addictive potential is somewhat lower than that of lorazepam and cannabis (non-hypnotic reference) approximately in the range of that of triazolam or zopiclon. The few published clinical case reports (n = 8) are mainly from Germany and describe distinct psychological (craving, loss of control, focusing of behaviour on the use and procurement of the substance) and low levels of physical features of addiction (withdrawal symptoms, tolerance). On average, in the case reports 4.25 of 6 criteria of dependence (ICD-10) were met. The consumption of propofol is mainly limited to medical or medical-related occupations. Propofol has yet not arrived on the local black markets. An oral consumption appears not to occur or to be unattractive. The incentive of propofol’s ”high” (euphoria/relaxation) via the intravenous route is probably underestimated. This is supported by a high mortality rate (46.2 %) in the 78 reports on the consumption of propofol up to date. Forensic analyses consider mainly accidental respiratory arrests to be responsible for the deaths. In summary, propofol is considered to be a primary mental addictive substance that is characteristically intravenously consumed by persons within the medical profession. Because of its apparently narrow safety margin between pleasure and death, propofol is an extraordinary hazard which, unfortunately, is only reflected insufficiently in the scale of Griffith and Johnson.
Schlüsselwörter
Propofol - Abhängigkeitspotenzial - Mortalitätsrisiko
Keywords
propofol - addictive potential - mortality risk
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Prof. Dr. med. Udo Bonnet
Klinik für Psychiatrie und Psychotherapie, LVR-Klinikum Essen, Universität Duisburg/Essen
Virchowstr. 174
45147 Essen
Email: udo.bonnet@uni-due.de