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Erschienen in: Die Anaesthesiologie 9/2021

23.08.2021 | Anästhesiologisches Monitoring | Leitthema

Nozizeptionsmonitoring

Methode zur intraoperativen Opioidsteuerung?

verfasst von: Rainer Nitzschke, Marlene Fischer, Sandra Funcke

Erschienen in: Die Anaesthesiologie | Ausgabe 9/2021

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Zusammenfassung

Die intraoperative Dosierung von Opioiden stellt eine Herausforderung im anästhesiologischen Alltag dar; insbesondere, da potenzielle Effekte einer intraoperativen Über- oder Unterdosierung nicht vollständig geklärt sind. In den vergangenen Jahren wurde eine zunehmende Zahl von Monitoren zugelassen, die zur Detektion intraoperativer Nozizeption entwickelt wurden und eine bessere Steuerung der Opioidtitration ermöglichen sollen. Die Monitore nutzen entweder kontinuierliche hämodynamische, galvanische oder thermische Biosignale, um die Balance zwischen Sympathikus und Parasympathikus abzubilden, oder messen den Pupillendilatationsreflex oder den nozizeptiven Flexorenreflex als Reflexantwort auf standardisiert applizierte nozizeptive Reize. Dieser Übersichtsbeitrag stellt die aktuell zur Verfügung stehenden Nozizeptionsmonitore vor. Die meisten dieser Monitore detektieren nozizeptive Reize mit höherer Sensitivität und Spezifität, als es Herzfrequenz, Blutdruck oder Sedierungstiefemonitore können. Zum Effekt der durch einen Nozizeptionsmonitor unterstützten Opioidtitration und ihrem möglichen postoperativen Benefit gibt es bisher nur wenige Studien. Alle Messmethoden unterliegen spezifischen Limitationen, die sich durch perioperative „confounder“ (z. B. Hypovolämie) oder begleitende medizinische Konditionen (z. B. Muskelrelaxierung) ergeben. Die klinische Relevanz nozizeptiver Reize in der Allgemeinanästhesie und ihr Effekt auf das Patienten-Outcome werden kontrovers diskutiert. Erste Ergebnisse zeigen für einzelne Monitorsysteme sowohl eine Reduktion der Opioiddosis als auch eine Reduktion des postoperativen Schmerzniveaus. Eine klare Evidenz für eine Verbesserung des Langzeit-Outcome steht jedoch noch aus.
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Metadaten
Titel
Nozizeptionsmonitoring
Methode zur intraoperativen Opioidsteuerung?
verfasst von
Rainer Nitzschke
Marlene Fischer
Sandra Funcke
Publikationsdatum
23.08.2021
Verlag
Springer Medizin
Erschienen in
Die Anaesthesiologie / Ausgabe 9/2021
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI
https://doi.org/10.1007/s00101-021-01022-6