nach oben

Die Anaesthesiologie

Erschienen in:

22.06.2020 | Hypotonie | Leitthema

Perioperative medikamentöse Kreislaufunterstützung in der täglichen Routine

verfasst von: Dr. med. A. Haas, Univ.-Prof. Dr. med. T. Schürholz, Univ.-Prof. Dr. D. A. Reuter

Erschienen in: Die Anaesthesiologie | Ausgabe 11/2020

Einloggen, um Zugang zu erhalten

Zusammenfassung

Perioperative hypotensive Phasen sind mit der Zunahme von postoperativen Komplikationen und Organschäden assoziiert. Während noch vor einigen Jahren die hämodynamische Stabilisierung in erster Linie durch Volumengaben geprägt war, haben in letzter Zeit der Einsatz und auch die Dosierung kardiovaskulär aktiver Substanzen deutlich zugenommen. Wie für die intravasale Volumentherapie gilt auch für die Therapie mithilfe Herz-Kreislauf-wirksamer Substanzen, dass diese aufgrund ihrer geringen therapeutischen Breite Nebenwirkungen haben. Im vorliegenden Übersichtsbeitrag werden konkrete Indikationen der einzelnen kardiovaskulär aktiven Wirkstoffe mit den jeweiligen Vor- und Nachteilen diskutiert. Besonderer Fokus liegt auf der Fragestellung der Applikationsform: zentraler Venenkatheter vs. periphere Venenverweilkanüle. Die Autoren kommen zu dem Schluss, dass sich nicht die Frage stellt, ob es prinzipiell erlaubt ist, Herz-Kreislauf wirksame Medikamente periphervenös zu applizieren, sondern vielmehr, was dabei zu beachten ist. Der Beitrag gibt entsprechende Empfehlungen.

Futier E, Lefrant JY, Guinot PG et al (2017) Effect of individualized vs standard blood pressure management strategies on postoperative organ dysfunction among high-risk patients undergoing major surgery: a randomized clinical trial. JAMA 318(14):1346–1357

Maheshwari K, Turan A, Mao G et al (2018) The association of hypotension during non-cardiac surgery, before and after skin incision, with postoperative acute kidney injury: a retrospective cohort analysis. Anaesthesia 73(10):1223–1228

Saugel B, Kouz K, Hoppe P, Maheshwari K, Scheeren TWL (2019) Predicting hypotension in perioperative and intensive care medicine. Best Pract Res Clin Anaesthesiol 33(2):189–197

Welte M, Saugel B, Reuter DA (2020) Perioperatives Blutdruckmanagement. Was ist der optimale Druck? Anästhesist. https://doi.org/10.1007/s00101-020-00767-w. Online ahead of printCrossRef

Reuter DA, Chappell D, Perel A (2018) The dark sides of fluid administration in the critically ill patient. Intensive Care Med 44(7):1138–1140

Chappell D, Bruegger D, Potzel J et al (2014) Hypervolemia increases release of atrial natriuretic peptide and shedding of the endothelial glycocalyx. Crit Care 18(5):538

Navarro LH, Bloomstone JA, Auler JO Jr. et al (2015) Perioperative fluid therapy: a statement from the international fluid optimization group. Perioper Med 4:3

Vincent JL, De Backer D (2013) Circulatory shock. N Engl J Med 369(18):1726–1734

Vincent JL, Cecconi M, Saugel B (2019) Is this patient really “(un)stable”? How to describe cardiovascular dynamics in critically ill patients. Crit Care 23(1):272

10.

Saugel B, Kouz K, Scheeren TWL (2019) The “5 Ts” of perioperative goal-directed haemodynamic therapy. Br J Anaesth 123(2):103–107

11.

Kasaba T, Kondou O, Yoshimura Y, Watanabe Y, Takasaki M (1998) Haemodynamic effects of induction of general anaesthesia with propofol during epidural anaesthesia. Can J Anaesth 45(11):1061–1065

12.

Robinson BJ, Ebert TJ, O’Brien TJ, Colinco MD, Muzi M (1997) Mechanisms whereby propofol mediates peripheral vasodilation in humans. Sympathoinhibition or direct vascular relaxation? Anesthesiology 86(1):64–72

13.

Sudfeld S, Brechnitz S, Wagner JY et al (2017) Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia. Br J Anaesth 119(1):57–64

14.

Lambden S, Creagh-Brown BC, Hunt J, Summers C, Forni LG (2018) Definitions and pathophysiology of vasoplegic shock. Crit Care 22(1):174

15.

Andreis DT, Singer M (2016) Catecholamines for inflammatory shock: a Jekyll-and-Hyde conundrum. Intensive Care Med 42(9):1387–1397

16.

Monnet X, Jabot J, Maizel J, Richard C, Teboul JL (2011) Norepinephrine increases cardiac preload and reduces preload dependency assessed by passive leg raising in septic shock patients. Crit Care Med 39(4):689–694

17.

Martin C, Papazian L, Perrin G, Saux P, Gouin F (1993) Norepinephrine or dopamine for the treatment of hyperdynamic septic shock? Chest 103(6):1826–1831

18.

Mueller H, Ayres SM, Gregory JJ, Giannelli S Jr., Grace WJ (1970) Hemodynamics, coronary blood flow, and myocardial metabolism in coronary shock; response of 1‑norepinephrine and isoproterenol. J Clin Invest 49(10):1885–1902

19.

Van Maanen EF, Banning JW, Roebel LE, Morgan JP (1988) Dopamine and norepinephrine increase venous return by stimulating alpha and beta adrenoceptors in the dog. J Cardiovasc Pharmacol 11(6):627–634

20.

Hamzaoui O, Georger JF, Monnet X et al (2010) Early administration of norepinephrine increases cardiac preload and cardiac output in septic patients with life-threatening hypotension. Crit Care 14(4):R142

21.

Shen T, Baker K (2015) Venous return and clinical hemodynamics: how the body works during acute hemorrhage. Am J Physiol 39(4):267–271

22.

Greenway CV, Seaman KL, Innes IR (1985) Norepinephrine on venous compliance and unstressed volume in cat liver. Am J Physiol 248(4 Pt 2):H468–76

23.

Rothe CF (1986) Physiology of venous return. An unappreciated boost to the heart. Arch Intern Med 146(5):977–982

24.

Georger JF, Hamzaoui O, Chaari A, Maizel J, Richard C, Teboul JL (2010) Restoring arterial pressure with norepinephrine improves muscle tissue oxygenation assessed by near-infrared spectroscopy in severely hypotensive septic patients. Intensive Care Med 36(11):1882–1889

25.

Annane D, Ouanes-Besbes L, de Backer D et al (2018) A global perspective on vasoactive agents in shock. Intensive Care Med 44(6):833–846

26.

van Loon LM, Stolk RF, van der Hoeven JG et al (2020) Effect of vasopressors on the macro- and microcirculation during systemic inflammation in humans in vivo. Shock 53(2):171–174. https://doi.org/10.1097/SHK.0000000000001357CrossRef

27.

Legrand M, De Backer D, Depret F, Ait-Oufella H (2019) Recruiting the microcirculation in septic shock. Ann Intensive Care 9(1):102

28.

Poterman M, Vos JJ, Vereecke HE et al (2015) Differential effects of phenylephrine and norepinephrine on peripheral tissue oxygenation during general anaesthesia: a randomised controlled trial. Eur J Anaesthesiol 32(8):571–580

29.

George RB, Boyd C, McKeen D, Abdo IS, Lehmann C (2019) Possible impact of spinal anesthesia and phenylephrine on sublingual microcirculation of cesarean delivery patients. J Clin Med Res 11(8):543–549

30.

Zunic M, Krcevski Skvarc N, Kamenik M (2019) The influence of the infusion of ephedrine and phenylephrine on the hemodynamic stability after subarachnoid anesthesia in senior adults—a controlled randomized trial. BMC Anesthesiol 19(1):207

31.

Hayakawa-Fujii Y, Iida H, Dohi S (1999) Propofol anesthesia enhances pressor response to ephedrine in patients given clonidine. Anesth Analg 89(1):37–41

32.

Yamamoto K, Ikeda U, Okada K et al (1997) Arginine vasopressin increases nitric oxide synthesis in cytokine-stimulated rat cardiac myocytes. Hypertension 30(5):1112–1120

33.

Holmes CL, Walley KR, Chittock DR, Lehman T, Russell JA (2001) The effects of vasopressin on hemodynamics and renal function in severe septic shock: a case series. Intensive Care Med 27(8):1416–1421

34.

Schwarte LA, Schwartges I, Schober P, Scheeren TW, Fournell A, Picker O (2010) Sevoflurane and propofol anaesthesia differentially modulate the effects of epinephrine and norepinephrine on microcirculatory gastric mucosal oxygenation. Br J Anaesth 105(4):421–428

35.

Nacul FE, Guia IL, Lessa MA, Tibirica E (2010) The effects of vasoactive drugs on intestinal functional capillary density in endotoxemic rats: intravital video-microscopy analysis. Anesth Analg 110(2):547–554

36.

Sakka SG, Hofmann D, Thuemer O, Schelenz C, van Hout N (2007) Increasing cardiac output by epinephrine after cardiac surgery: effects on indocyanine green plasma disappearance rate and splanchnic microcirculation. J Cardiothorac Vasc Anesth 21(3):351–356

37.

Heringlake M, Wernerus M, Grunefeld J et al (2007) The metabolic and renal effects of adrenaline and milrinone in patients with myocardial dysfunction after coronary artery bypass grafting. Crit Care 11(2):R51

38.

Meier-Hellmann A, Reinhart K, Bredle DL, Specht M, Spies CD, Hannemann L (1997) Epinephrine impairs splanchnic perfusion in septic shock. Crit Care Med 25(3):399–404

39.

Kastrup M, Markewitz A, Spies C et al (2007) Current practice of hemodynamic monitoring and vasopressor and inotropic therapy in post-operative cardiac surgery patients in Germany: results from a postal survey. Acta Anaesthesiol Scand 51(3):347–358

40.

Habicher M, Zajonz T, Heringlake M, Böning A, Treskatsch S, Schirmer U, Markewitz A, Sander M (2018) S3 guidelines on intensive medical care of cardiac surgery patients: Hemodynamic monitoring and cardiovascular system – an update. Anaesthesist 67(5):375–379. https://doi.org/10.1007/s00101-018-0433-6CrossRef

41.

Moller MH, Granholm A, Junttila E et al (2018) Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure. Acta Anaesthesiol Scand 62(4):420–450

42.

Fink T, Heymann P, Taha-Melitz S et al (2013) Dobutamine pretreatment improves survival, liver function, and hepatic microcirculation after polymicrobial sepsis in rat. Shock 40(2):129–135

43.

Chiarandini P, Pompei L, Costa MG et al (2013) Effects of catecholamines on microcirculation during general inhalation anesthesia. J Cardiothorac Vasc Anesth 27(6):1239–1245

44.

Bomberg H, Bierbach B, Flache S, Novak M, Schafers HJ, Menger MD (2019) Dobutamine versus vasopressin after mesenteric ischemia. J Surg Res 235:410–423

45.

Hernandez G, Bruhn A, Luengo C et al (2013) Effects of dobutamine on systemic, regional and microcirculatory perfusion parameters in septic shock: a randomized, placebo-controlled, double-blind, crossover study. Intensive Care Med 39(8):1435–1443

46.

Lopes de Miranda M, Pereira SJ, Santos AO, Villela NR, Kraemer-Aguiar LG, Bouskela E (2015) Milrinone attenuates arteriolar vasoconstriction and capillary perfusion deficits on endotoxemic hamsters. PLoS ONE 10(2):e117004

47.

Schwarte LA, Picker O, Bornstein SR, Fournell A, Scheeren TW (2005) Levosimendan is superior to milrinone and dobutamine in selectively increasing microvascular gastric mucosal oxygenation in dogs. Crit Care Med 33(1):135–142 (discussion 246–7)

48.

Kloth B, Pecha S, Moritz E et al (2017) Akrinor(TM), a cafedrine/theodrenaline mixture (20:1), increases force of contraction of human atrial myocardium but does not constrict internal mammary artery in vitro. Front Pharmacol 8:272

49.

Weitzel M, Hammels P, Schorer C, Klingler H, Weyland A (2018) Hemodynamic effects of cafedrine/theodrenaline on anesthesia-induced hypotension. Anaesthesist 67(10):766–772

50.

Chappell D, Helf A, Gayer J, Eberhart L, Kranke P (2019) Antihypotensive drugs in cesarean sections : treatment of arterial hypotension with ephedrine, phenylephrine and akrinor(R) (cafedrine/theodrenaline) during cesarean sections with spinal anesthesia. Anaesthesist 68(4):228–238

51.

Saugel B, Reese PC, Sessler DI et al (2019) Automated ambulatory blood pressure measurements and intraoperative hypotension in patients having noncardiac surgery with general anesthesia: a prospective observational study. Anesthesiology 131(1):74–83

52.

Kaufmann T, Saugel B, Scheeren TWL (2019) Perioperative goal-directed therapy—what is the evidence? Best Pract Res Clin Anaesthesiol 33(2):179–187

53.

Rhodes A, Evans LE, Alhazzani W et al (2017) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 43(3):304–377

54.

Levy MM, Evans LE, Rhodes A (2018) The surviving sepsis campaign bundle: 2018 update. Crit Care Med 46(6):997–1000

55.

Moller MH, Claudius C, Junttila E et al (2016) Scandinavian SSAI clinical practice guideline on choice of first-line vasopressor for patients with acute circulatory failure. Acta Anaesthesiol Scand 60(10):1347–1366

56.

Hajjar LA, Vincent JL, Barbosa Gomes Galas FR et al (2017) Vasopressin versus norepinephrine in patients with vasoplegic shock after cardiac surgery: the VANCS randomized controlled trial. Anesthesiology 126(1):85–93

57.

Hajjar LA, Zambolim C, Belletti A et al (2019) Vasopressin versus norepinephrine for the management of septic shock in cancer patients: the VANCS II randomized clinical trial. Crit Care Med 47(12):1743–1750

58.

McIntyre WF, Um KJ, Alhazzani W et al (2018) Association of vasopressin plus catecholamine vasopressors vs catecholamines alone with atrial fibrillation in patients with distributive shock: a systematic review and meta-analysis. JAMA 319(18):1889–1900

59.

Honarmand K, Um KJ, Belley-Cote EP et al (2020) Canadian critical care society clinical practice guideline: the use of vasopressin and vasopressin analogues in critically ill adults with distributive shock. Can J Anaesth 67(3):369–376. https://doi.org/10.1007/s12630-019-01546-xCrossRef

60.

Bayerl S, Wohrle T, Kilger E (2020) Vasopressin in distributive shock : brief summary of the guidelines of the Canadian critical care society published in december 2019. Anaesthesist 69(3):159–161

61.

Lord MS, Augoustides JG (2012) Perioperative management of pheochromocytoma: focus on magnesium, clevidipine, and vasopressin. J Cardiothorac Vasc Anesth 26(3):526–531

62.

Leopold V, Gayat E, Pirracchio R et al (2018) Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of 2583 patients. Intensive Care Med 44(6):847–856

63.

Belletti A, Nagy A, Sartorelli M et al (2020) Effect of continuous epinephrine infusion on survival in critically ill patients. A meta-analysis of randomized trials. Crit Care Med 48(3):398–405. https://doi.org/10.1097/CCM.0000000000004127CrossRef

64.

Sauerland C, Engelking C, Wickham R, Corbi D (2006) Vesicant extravasation part I: mechanisms, pathogenesis, and nursing care to reduce risk. Oncol Nurs Forum 33(6):1134–1141

65.

Le A, Patel S (2014) Extravasation of noncytotoxic drugs: a review of the literature. Ann Pharmacother 48(7):870–886

66.

Kuwahara T, Asanami S, Kawauchi Y, Kubo S (1999) Experimental infusion phlebitis: tolerance pH of peripheral vein. J Toxicol Sci 24(2):113–121

67.

Lewis T, Merchan C, Altshuler D, Papadopoulos J (2019) Safety of the peripheral administration of vasopressor agents. J Intensive Care Med 34(1):26–33

68.

Loubani OM, Green RS (2015) A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters. J Crit Care 30(3):653.e9–17

69.

Humphreys J, Johnston JH, Richardson JC (1955) Skin necrosis following intravenous noradrenaline. BMJ 2(4950):1250–1252

70.

Perlow S, Shapiro RA (1956) Skin necrosis following intravenous use of norepinephrine; report of six cases. Am J Surg 92(4):566–570

71.

Cardenas-Garcia J, Schaub KF, Belchikov YG, Narasimhan M, Koenig SJ, Mayo PH (2015) Safety of peripheral intravenous administration of vasoactive medication. J Hosp Med 10(9):581–585

72.

Russell JA, Gordon AC, Walley KR (2019) Early may be better: early low-dose norepinephrine in septic shock. Am J Respir Crit Care Med 199(9):1049–1051

73.

Hallengren M, Astrand P, Eksborg S, Barle H, Frostell C (2017) Septic shock and the use of norepinephrine in an intermediate care unit: mortality and adverse events. PLoS ONE 12(8):e183073

74.

Lampin ME, Rousseaux J, Botte A, Sadik A, Cremer R, Leclerc F (2012) Noradrenaline use for septic shock in children: doses, routes of administration and complications. Acta Paediatr 101(9):e426–30

75.

Turner DA, Kleinman ME (2010) The use of vasoactive agents via peripheral intravenous access during transport of critically III infants and children. Pediatr Emerg Care 26(8):563–566

Titel: Perioperative medikamentöse Kreislaufunterstützung in der täglichen Routine
verfasst von: Dr. med. A. Haas
Univ.-Prof. Dr. med. T. Schürholz
Univ.-Prof. Dr. D. A. Reuter
Publikationsdatum: 22.06.2020
Verlag: Springer Medizin
Schlagwörter: Hypotonie
Zentraler Venenkatheter
Hypotonie
Erschienen in: Die Anaesthesiologie / Ausgabe 11/2020
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI: https://doi.org/10.1007/s00101-020-00803-9

Passend zum Thema

SGLT-2-Inhibitoren für alle Patient:innen mit chronischer Herzinsuffizienz empfohlen

Niere und Herz

Das ESC-Leitlinien-Update 2023 bedeutet einen Paradigmenwechsel in der Behandlung der Herzinsuffizienz (HF), denn nun werden SGLT-2i sowohl für HFrEF, als auch für HFmrEF und HFpEF empfohlen. Somit können jetzt alle Patient:innen mit HF von SGLT-2i als zentralem Bestandteil der Therapie profitieren.

Dapagliflozin als neue Therapieoption zur Behandlung einer Herzinsuffizienz unabhängig von der Ejektionsfraktion

Niere und Herz

Dapagliflozin ist nun zur Behandlung aller Patient:innen mit chronischer symptomatischer Herzinsuffizienz zugelassen und bietet somit auch neue Hoffnung für die Therapie von jenen mit HFpEF. In der DELIVER-Studie zeigte der SGLT-2-Inhibitor eine signifikante Reduktion von Herzinsuffizienz-Hospitalisierungen und CV-Todesfällen.

ACS-Erstlinientherapie: Konsensbeschluss rät zur DAPT mit Ticagrelor

Niere und Herz

Ein Konsortium führender Fachgesellschaften erarbeitete jüngst auf Basis umfangreicher Metaanalysen einen Konsens für die Therapie koronarer Herzkrankheiten. Was dabei auffiel: Die duale Plättchenhemmung (DAPT) mit Ticagrelor ist die bevorzugte Therapieoption für das akute Koronarsyndrom (ACS).

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 11/2020

Akzidentelle Fixierung eines Pulmonalarterienkatheters während einer Herztransplantation

Langzeitoutcome perioperativer Schmerztherapie erhoben an Routinedaten (LOPSTER)

Fokus allgemeine Intensivmedizin

Persönlichkeitseigenschaften in der Anästhesiologie

Das richtigte Herz-Kreislauf-Medikament - was, wann und wie?

CME: Spezifische Therapie des akuten Lungenversagens

Passend zum Thema

SGLT-2-Inhibitoren für alle Patient:innen mit chronischer Herzinsuffizienz empfohlen

Dapagliflozin als neue Therapieoption zur Behandlung einer Herzinsuffizienz unabhängig von der Ejektionsfraktion

ACS-Erstlinientherapie: Konsensbeschluss rät zur DAPT mit Ticagrelor