Adjuvanzien in der modernen Anästhesie – Magnesium

Zusammenfassung

Magnesium spielt eine Schlüsselrolle in vielen verschiedenen enzymatischen und zellulären Prozessen und ist daher von wachsendem Interesse für die perioperative Medizin. Während experimentelle Studien vielversprechende Ansätze für verschiedene Krankheitsbilder liefern, sind die Ergebnisse großer klinischer Studien widersprüchlich. Potentielle Indikationen und Therapieempfehlungen werden ebenso wie die zugrundeliegende Physiologie in vorliegendem Übersichtsartikel vorgestellt.

Abstract

Magnesium plays a key role in many cellular functions and there is growing interest in its role in perioperative medicine. While experimental studies provided promising results for several disease states, clinical trials mainly gave conflicting results. This review article summarizes current knowledge on the homeostasis of magnesium as well as on its proposed indications and recommendations in the clinical setting.

Kernaussagen

• Magnesium ist ein essenzielles Mineralsalz und als zweithäufigstes intrazelluläres Kation an > 600 enzymatischen Prozessen und zahlreichen biologischen Funktionen, wie Proteinbiosynthese und Energiestoffwechsel, beteiligt.

• Magnesium ist Kofaktor verschiedener ATPasen und moduliert sowohl Ionenkanäle als auch die Signalübertragung ionotroper und metabotroper Rezeptoren.

• Der menschliche Körper enthält 24 g (1 mol) Magnesium, wovon sich nur 0,3 % im Plasma befinden.

• Die Magnesium-Homöostase wird v. a. durch enterale Absorption und renale Exkretion aufrechterhalten.

• Magnesium scheint analgetische und anästhetikasparende Eigenschaften zu besitzen.

• Magnesium verlängert die neuromuskuläre Blockade durch nicht depolarisiernde Muskelrelaxanzien und verkürzt deren Anschlagszeit: Im klinischen Alltag ist ein Relaxometer daher unerlässlich.

• Die schwere Präeklampsie und Eklampsie sind neben der Torsades-de-pointes-Arrhythmie die klassischen Indikationen einer systemischen Magnesiumgabe.

• Magnesium besitzt keinen Stellenwert in der Therapie des Herzinfarkts und des Herz-Kreislauf-Stillstands.

• Beim schweren Asthmaanfall kann bei Kindern und Erwachsenen die Gabe von i. v. Magnesium erwogen werden.

• Patienten mit Schlaganfall oder Subarachnoidalblutung scheinen von einer Therapie mit i. v. Magnesium nicht zu profitieren.

Schlüsselwörter:

Magnesium - klinische Indikationen - Homöostase

Key words:

magnesium - clinical indications - homeostasis

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