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Erschienen in: Der Anaesthesist 4/2017

31.01.2017 | Anästhetika | Intensivmedizin

Neue technische Entwicklungen der inhalativen Sedierung

verfasst von: Dr. A. Meiser, H. Bomberg, T. Volk, H. V. Groesdonk

Erschienen in: Die Anaesthesiologie | Ausgabe 4/2017

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Zusammenfassung

Seit über hundert Jahren verwenden wir das Kreisteil in Narkosegeräten. Dabei wird die gesamte Ausatemluft nach Kohlendioxidabsorption rückgeatmet. Vor 15 Jahren erfolgte die erste klinische Anwendung eines Anästhetikareflektors. Ein Reflektor arbeitet mit Pendelluft, hält spezifisch nur das Anästhetikum bei der Ausatmung fest und gibt es bei der Einatmung wieder ab. Eine hohe Reflexionseffizienz (Anzahl wieder eingeatmeter/Anzahl ausgeatmeter Anästhetikamoleküle, RE 80–90 %) bedingt einen niedrigen Verbrauch. Analog zum Frischgasfluss beim Kreisteil beschreibt die pulmonale Clearance ((1-RE) × Atemminutenvolumen) die Opposition zwischen Verbrauch und Steuerbarkeit.
Erst die Vorteile der Reflexionssysteme ermöglichten den routinemäßigen Einsatz volatiler Anästhetika auf Intensivstationen. Einfache Handhabung sowie bessere Beatmungseigenschaften von Intensiv- versus Anästhesierespiratoren sind Grundvoraussetzungen hierfür. Neben AnaConDa™ (Sedana Medical, Uppsala, Schweden) ist mit MIRUS™ (Pall Medical, Dreieich, Deutschland) nun ein zweites, technisch weiterentwickeltes Reflexionssystem kommerziell erhältlich.
Die Ausnutzung organprotektiver Effekte, die exzellente Steuerbarkeit sowie eine dosisabhängige tiefe Sedierung bei erhaltener Spontanatmung ohne nennenswerte Kumulation und Toleranzentwicklung lassen volatile Anästhetika als interessante Alternative erscheinen, insbesondere für Patienten, die eine tiefe Sedierung benötigen oder bei denen intravenöse Sedativa nicht mehr anschlagen.
Erste Untersuchungen zum Langzeitüberleben deuten darauf hin, dass tiefe intravenöse Sedierungen nachteilig sind, inhalative Sedierungen hingegen mit Vorteilen verbunden sein könnten. Prospektive Studien zur Mortalität, aber auch zum psychologischen Outcome stehen allerdings noch aus.
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Metadaten
Titel
Neue technische Entwicklungen der inhalativen Sedierung
verfasst von
Dr. A. Meiser
H. Bomberg
T. Volk
H. V. Groesdonk
Publikationsdatum
31.01.2017
Verlag
Springer Medizin
Erschienen in
Die Anaesthesiologie / Ausgabe 4/2017
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI
https://doi.org/10.1007/s00101-017-0269-5

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