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Anästhesiol Intensivmed Notfallmed Schmerzther 2001; 36(5): 268-275
DOI: 10.1055/s-2001-14471
ÜBERSICHT
© Georg Thieme Verlag Stuttgart · New York

Sympathisch vermittelte Kreislaufregulation während Allgemeinanästhesie

Sympathetic Control Mechanisms During General AnesthesiaP. Kienbaum1 , J. Peters2
  • 1Funktionsoberarzt, Abteilung für Anästhesiologie und
    Intensivmedizin, Universitätsklinikum Essen, Essen
  • 2Professor für Anästhesiologie und Intensivtherapie,
    Direktor, Abteilung für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen
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Publication History

Publication Date:
31 December 2001 (online)

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Zusammenfassung.

Seit über 100 Jahren untersuchen Wissenschaftler die Funktion des sympathischen Nervensystems, des wichtigsten physiologischen Kreislaufkontrollsystems. Die Muskelsympathikusaktivität in Ruhe und ihre reflektorische Aktivitätszunahme durch Kreislaufstressoren stellt dabei die wesentliche Variable zur Beurteilung von Anästhetika-Effekten beim Menschen dar. Die vorliegende Übersichtsarbeit stellt die Kenntnisse im Hinblick auf das sympathische Nervensystem zusammen und betrachtet die Wirkungen von Injektions- und Inhalationsanästhetika auf den Muskelsympathikus. Die Anästhetika Etomidate und Ketamin sowie eine Inhalationsanästhesie mit niedrig dosiertem Isofluran, Stickoxydul und Opioiden beeinträchtigen sympathische Kreislaufregulationsmechanismen am geringsten und sind damit unter hämodynamischen Gesichtspunkten für die Aufrechterhaltung eines ausreichenden arteriellen Blutdruckes insbesondere bei Patienten mit bereits aktivierten sympathischen Kompensationsmechanismen empfehlenswert.

Sympathetic Control Mechanisms During General Anesthesia.

For more than 100 years scientists have studied the sympathetic nervous system and its cardiovascular control mechanisms. Muscle sympathetic activity is the most important direct and rapidly responding variable for evaluation of sympathetic neural outflow. Therefore, anesthesiologists have been interested in the effects of anesthetics on muscle sympathetic activity at rest and during cardiovascular challenges. This review summarizes effects of positive pressure ventilation, intravenous and inhalational anesthetics as well as nitrous oxide on sympathetic muscle outflow. The least depression of both resting sympathetic outflow and its response to challenges is observed following administration of etomidate, ketamine, or a combination of low dose isoflurane/nitrous oxide and opioids. Thus, these anesthetics can be recommended for anesthesia in patients with already activated sympathetic outflow to maintain arterial blood pressure.

Schlüsselwörter:

Allgemeinanästhesie - Sympathisches Nervensystem - Katecholamine - Mikroneurographie - Muskelsympathikusaktivität - Kreislaufreflexe - Injektionsanästhetika - Stickoxydul - Inhalationsanästhetika

Key words:

General Anesthesia - Sympathetic Nervous System - Catecholamines - Microneurography - Muscle Sympathetic Activity - Baroreflex - iv-Anesthetics - Volatile Anesthetics - Nitrous Oxide

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Dr. med. Peter Kienbaum

Abteilung für Anästhesiologie und Intensivmedizin
Universitätsklinikum Essen

Hufelandstraße 55

45122 Essen

Email: peter.kienbaum@uni-essen.de