Kernaussagen
α2-Agonisten spielen heute eine wichtige Rolle in
der Anästhesie und Intensivmedizin. Bei sachgemäßem Einsatz
sind die Nebenwirkungen substanzspezifisch und vorhersehbar. Die Kombination
aus sedierenden und analgetischen Eigenschaften bei gleichzeitig fehlender
Atemdepression und einer Glättung der hämodynamischen Schwankungen
durch sympatholytische Eigenschaften weisen auf die günstigen Wirkungen
dieser Substanzklasse hin. Überdies induziert Dexmedetomidin eine
einzigartige, dem natürlichen Schlaf ähnliche Sedierung und kann die
Delir-Prävalenz beatmeter Patienten reduzieren.
Dexmedetomidin ist zugelassen zur Sedierung erwachsener
Intensivpatienten, die eine Sedierungstiefe benötigen, welche ein Erwecken
durch verbale Stimulation noch erlaubt (RASS 0 bis –3). Anders als
Clonidin, das bisher meist primär als Adjuvans eingesetzt wird und keine
Zulassung als Monosedativum hat, kann man Dexmedetomidin in solchen Situationen
daher als primäres Sedativum verwenden – ergänzt durch
Analgetika und ggf. zusätzliche Sedativa.
Die spezifischen Anwendungsgebiete bei kritisch kranken
Intensivpatienten unter Berücksichtigung der Grunderkrankung müssen
sicher noch durch weitere Untersuchungen und Erfahrungen in der klinischen
Praxis genauer definiert werden. Ebenso muss sich zeigen, ob die bisher in
Studien gefundenen günstigen Effekte bezüglich der
Delirhäufigkeit und der Reduktion der Beatmungsdauer bestätigt werden
können [10]
[39]
[40]. Nach bisherigen Daten kann Dexmedetomidin potenziell
eine wichtige Bereicherung des pharmakologischen Armamentariums in der
Anästhesie und Intensivmedizin sein. Weitere Untersuchungen sind aber
notwendig, um abschließend eine Nutzen-Risiko-Analyse vornehmen zu
können.
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e1-e3
Prof. Peter H. Tonner
Klinikum Links der Weser GmbH
Klinik für
Anästhesie, operative und allg. Intensivmedizin, Notfallmedizin
Senator-Weßling-Str. 1
28277 Bremen
eMail: peter.tonner@klinikum-bremen-ldw.de
