Auf volatile Anästhetika kann verzichtet werden - Kontra

Volatile Anästhetika sind seit Jahrzehnten eine wesentliche Komponente der Anästhesie, wobei mit der Einführung neuer Substanzen die Nutzen-/Risiko-Relation immer weiter verbessert wurde. Im Folgenden soll - vorrangig im Vergleich zu intravenösen Anästhesieverfahren - dargelegt werden, welche Aspekte heute für den bevorzugten Einsatz volatiler Anästhetika sprechen.

Möglichkeit der inhalativen Einleitung, günstige Pharmakokinetik, Monitoring der alveolären Konzentration, rasche Erholung nach kurz und lang dauernden Narkosen, Bronchialdilatation bei Asthma und COPD, weitgehend stabile Kreislaufregulation, kardioprotektive Effekte bei koronarer Herzkrankheit, verbesserte Oxygenierung kritisch minderperfundierter Gehirnareale, Fehlen von Histaminfreisetzung und IgE-vermittelter Anaphylaxie, uneingeschränkter Einsatz bei Leber- und Nierenerkrankungen, keine Schädigung des Pankreas, Einsparung an Muskelrelaxantien, niedrige Kosten.

Literatur

• 1 Hobbhahn J. Inhalationsanästhesie. In: Kochs E, Krier C, Buzello W, Adams HA (eds) Anästhesiologie. Stuttgart; Thieme 2001: 604-618
• 2 Bailey J M. Context-sensitive half-times and other decrement times of inhaled anesthetics.  Anesth Analg. 1997;  85 681-686
• 3 Mellinghoff H, Nigrovic V. Klinisch-pharmakologische Grundlagen der Anästhesiologie. In: Kochs E, Krier C, Buzello W, Adams HA (eds) Anästhesiologie. Stuttgart; Thieme 2001: 163-715
• 4 Fechner J, Schwilden H, Schüttler J. Intravenöse Anästhesie. In: Kochs E, Krier C, Buzello W, Adams HA (eds) Anästhesiologie. Stuttgart; Thieme 2001: 619-632
• 5 Hering W, Schüttler J. Intravenöse Anästhetika. In: Kochs E, Krier C, Buzello W, Adams HA (eds) Anästhesiologie. Stuttgart; Thieme 2001: 210-227
• 6 Bergman I J, Kluger M T, Short T G. Awareness during general anaesthesia: a review of 81 cases from the Anaesthetic Incident Monitoring Study.  Anaesthesia. 2002;  57 549-556
• 7 Domino K B, Posner K L, Caplan R A, Cheney F W. Awareness during anesthesia: a closed claims analysis.  Anesthesiology. 1999;  90 1053-1061
• 8 Hoymork S C, Raeder J, Grimsmo B, Steen P A. Bispectral index, predicted and measured drug levels of target-controlled infusions of remifentanil and propofol during laparoscopic cholecystectomy and emergence.  Acta Anaesthesiologica Scandinavica. 2000;  44 1138-1144
• 9 Bevan J C, Veall G R, Macnab A J. et al . Midazolam premedication delays recovery after propofol without modifying involuntary movements.  Anesth Analg. 1997;  85 50-54
• 10 Hamaoka N, Oda Y, Hase I. et al . Propofol decreases the clearance of midazolam by inhibiting CYP3A4: An in vivo and in vitro study.  Clinical Pharmacology & Therapeutics. 1999;  66 110-117
• 11 Viitanen H, Annila P, Viitanen M, Tarkkila P. Premedication with midazolam delays recovery after ambulatory sevoflurane anesthesia in children.  Anesth Analg. 1999;  89 75-79
• 12 Wiesner G, Wild K, Merz M, Hobbhahn J. Rates of awakening, circulatory parameters and side-effects with sevoflurane and enflurane. An open, randomized, comparative phase III study.  Anasthesiol Intensivmed Notfallmed Schmerzther. 1995;  30 290-296
• 13 Goto T, Saito H, Nakata Y. et al . Emergence times from xenon anaesthesia are independent of the duration of anaesthesia.  Br J Anaesth. 1997;  79 595-599
• 14 Juvin P, Servin F, Giraud O, Desmonts J M. Emergence of elderly patients from prolonged desflurane, isoflurane, or propofol anesthesia.  Anesth Analg. 1997;  85 647-651
• 15 Juvin P, Vadam C, Malek L. et al . Postoperative Recovery After Desflurane, Propofol, or Isoflurane Anesthesia Among Morbidly Obese Patients: A Prospective, Randomized Study.  Anesth Analg. 2000;  91 714-719
• 16 Karthikeyan S, Balachandran S, Cort J. et al . Anaesthesia for cardioversion: a comparison of sevoflurane and propofol.  Anaesthesia. 2002;  57 1114-1119
• 17 Raeder J, Gupta A, Pedersen F M. Recovery characteristics of sevoflurane- or propofol-based anaesthesia for day-care surgery.  Acta Anaesthesiol Scand. 1997;  41 988-994
• 18 Wrigley S R, Fairfield J E, Jones R M, Black A E. Induction and recovery characteristics of desflurane in day case patients: A comparison with propofol.  Anaesthesia. 1991;  46 615-622
• 19 Wilhelm W, Berg K, Langhammer A. et al . Remifentanil in gynecologic laparoscopy. A comparison of consciousness and circulatory effects of a combination with desflurane and propofol.  Anasthesiol Intensivmed Notfallmed Schmerzther. 1998;  33 552-556
• 20 Jellish W S, Lien C A, Fontenot H J, Hall R. The comparative effects of sevoflurane versus propofol in the induction and maintenance of anesthesia in adult patients.  Anesth Analg. 1996;  82 479-485
• 21 Ku A S, Hu Y, Irwin M G. et al . Effect of sevoflurane/nitrous oxide versus propofol anaesthesia on somatosensory evoked potential monitoring of the spinal cord during surgery to correct scoliosis.  Br J Anaesth. 2002;  88 502-507
• 22 Song D, Joshi G P, White P. Fast-track eleigibilty after ambulatory anesthesia: a comparison of desflurane, sevoflurane, and propofol.  Anesth Analg. 1998;  86 267-273
• 23 Song D, Chung F, Wong J, Yogendran S. The assessment of postural stability after ambulatory anesthesia: a comparison of desflurane with propofol.  Anesth Analg. 2002;  94 60-64
• 24 Sundman E, Witt H, Sandin R. et al . Pharyngeal function and airway protection during subhypnotic concentrations of propofol, isoflurane, and sevoflurane: volunteers examined by pharyngeal videoradiography and simultaneous manometry.  Anesthesiology. 2001;  95 1125-1132
• 25 Nishiyama T, Hanaoka K. Propofol-induced bronchoconstriction: two case reports.  Anesth Analg. 2001;  93 645-646
• 26 Hattori J, Fujimura N, Kanaya N. et al . Bronchospasm induced by propofol in a patient with sick house syndrome.  Anesth Analg. 2003;  96 163-164
• 27 Keyl C, Schneider A, Hobbhahn J, Bernardi L. Sinusoidal neck suction for evaluation of baroreflex sensitivity during desflurane and sevoflurane anesthesia.  Anesth Analg. 2002;  95 1629-1236
• 28 Keyl C, Schneider A, Dambacher M. et al . Dynamic cardiocirculatory control during propofol anesthesia in mechanically ventilated patients.  Anesth Analg. 2000;  91 1188-1195
• 29 Tramer M R, Moore R A, McQuay H J. Propofol and bradycardia: causation, frequency and severity.  Br J Anaesth. 1997;  78 642-651
• 30 Goerlich T M, Foja C, Olthoff D. Die Auswirkungen von Sevofluran versus Propofol auf den okulokardialen Reflex - Eine vergleichende Untersuchung bei 180 Kindern. Effects of sevoflurane versus propofol on oculocardiac reflex - a comparative study in 180 children.  Anaesthesiol Reanim. 2000;  25 17-21
• 31 Conzen P F, Fischer S, Detter C, Peter K. Sevoflurane provides greater protection of the myocardium than propofol in patients undergoing off-pump coronary artery bypass surgery.  Anesthesiology. 2003;  99 826-833
• 32 Julier K, da Silva R, Garcia C. et al . Preconditioning by sevoflurane decreases biochemical markers for myocardial and renal dysfunction in coronary artery bypass graft surgery: a double-blinded, placebo-controlled, multicenter study.  Anesthesiology. 2003;  98 1315-1327
• 33 de Hert S G, Cromheecke S, ten Broecke P W. et al . Effects of propofol, desflurane, and sevoflurane on recovery of myocardial function after coronary surgery in elderly high-risk patients.  Anesthesiology. 2003;  99 314-323
• 34 de Hert S G, ten Broecke P W, Mertens E. et al . Sevoflurane but not propofol preserves myocardial function in coronary surgery patients.  Anesthesiology. 2002;  97 42-49
• 35 Penta de Peppo A, Polisca P, Tomai F. et al . Recovery of LV contractility in man is enhanced by preischemic administration of enflurane.  Ann Thorac Surg. 1999;  68 112-118
• 36 Belhomme D, Peynet J, Louzy M. et al . Evidence for preconditioning by isoflurane in coronary artery bypass graft surgery.  Circulation. 1999;  100 II340-II344
• 37 Hoffman W E, Charbel F T, Edelman G, Ausman J I. Thiopental and desflurane treatment for brain protection.  Neurosurgery. 1998;  43 1050-1053
• 38 Hoffman W E, Charbel F T, Edelman G. et al . Comparison of the effect of etomidate and desflurane on brain tissue gases and pH during prolonged middle cerebral artery occlusion.  Anesthesiology. 1998;  88 1188-1194
• 39 Jansen G F, van-Praagh B H, Kedaria M B, Odoom J A. Jugular bulb oxygen saturation during propofol and isoflurane/nitrous oxide anesthesia in patients undergoing brain tumor surgery.  Anesth Analg. 1999;  89 358-363
• 40 Werner C, Möllenberg O, Kochs E, Schulte am Esch J. Sevoflurane improves neurological outcome after incomplete cerebral ischaemia in rats.  Br J Anaesth. 1995;  75 756-760
• 41 Engelhard K, Werner C, Reeker W. et al . Desflurane and isoflurane improve neurological outcome after incomplete cerebral ischaemia in rats.  Br J Anaesth. 1999;  83 415-421
• 42 Kapinya K J, Lowl D, Futterer C. et al . Tolerance against ischemic neuronal injury can be induced by volatile anesthetics and is inducible NO synthase dependent.  Stroke. 2002;  33 1889-1898
• 43 Petersen K D, Landsfeldt U, Cold G E. et al . Intracranial pressure and cerebral hemodynamic in patients with cerebral tumors: a randomized prospective study of patients subjected to craniotomy in propofol-fentanyl, isoflurane-fentanyl, or sevoflurane-fentanyl anesthesia.  Anesthesiology. 2003;  98 329-336
• 44 Hobbhahn J, Hansen E, Conzen P, Peter K. Der Einfluss von Inhalationsanästhetika auf die Leber.  Anaesth Intensivmed. 1991;  32 215-220
• 45 Anand K, Ramsay M A, Crippin J S. Hepatocellular injury following the administration of propofol.  Anesthesiology. 2001;  95 1523-1524
• 46 Tiainen P, Lindgren L, Rosenberg P H. Changes in hepatocellular integrity during and after desflurane or isoflurane anaesthesia in patients undergoing breast surgery.  Br J Anaesth. 1998;  80 87-89
• 47 Tiainen P, Lindgren L, Rosenberg P H. Disturbance of hepatocellular integrity associated with propofol anaesthesia in surgical patients.  Acta Anaesthesiol Scand. 1995;  39 840-844
• 48 Betrosian A P, Balla M, Papanikolaou M. et al . Post-operative pancreatitis after propofol administration.  Acta Anaesthesiol Scand. 2001;  45 1052
• 49 Bird H, Brim V. Propofol and postoperative pancreatitis.  Anaesthesia. 2000;  55 506-507
• 50 Kumar A N, Schwartz D E, Lim K G. Propofol-induced pancreatitis: recurrence of pancreatitis after rechallenge.  Chest. 1999;  115 1198-1199