Zusammenfassung
Vasopressoren kommen besonders in kritischen, nicht selten lebensbedrohlichen Situationen
der Anästhesie, Notfall- und Intensivmedizin zum Einsatz. Die Wahl der geeigneten
Substanz sowie die Erkennung und Beherrschung möglicher Nebenwirkungen sind von großer
Bedeutung. Im folgenden Beitrag sollen daher die klinisch wichtigsten Substanzen vorgestellt
und deren pharmakologische Charakteristika beleuchtet werden.
Abstract
Levosimendan is a calcium sensitizer and opens adenosine triphosphate-dependent potassium
channels. Since 20 years, it is approved for acute decompensated heart failure. It
has been tested in many clinical trials for treatment of at-risk patients in cardiac
surgery, right ventricular failure, pulmonary hypertension, weaning of extracorporeal
systems, cardiogenic shock, septic shock, ARDS and others.
Levosimendan has diverse positive effects next to positive inotropy. It improves ventriculoarterial
coupling, increases peripheral perfusion, increases kidney glomerular filtration rate,
coronary blood flow and it reduces preload and afterload as well as pulmonary capillary
wedge pressure.
Due to the opening of potassium channels, it also acts on mitochondria resulting in
organ protection. Levosimendan acts anti-apoptotic. These positive effects were described
in many small studies. Although this sounds like a promising drug for a variety of
settings, results of several multicentre randomized placebo-controlled studies were
frustrating. This review resumes some facts of levosimendan in different diseases.
Schlüsselwörter
Levosimendan - Herzinsuffizienz - Kardiochirurgie - Inotropie - Sepsis
Key words
levosimendan - heart failure - cardiac surgery - inotropy - sepsis
