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

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