Das Sedierungsmanagement in der Intensivmedizin hat sich im letzten Jahrzehnt erheblich
gewandelt. In der modernen Intensivmedizin gilt die Maxime: so viel Sedierung wie
nötig, aber so wenig wie möglich. Muskelrelaxanzien sind daher nur noch in Einzelfällen
indiziert. Typische Indikationen sind lediglich die Notfallintubation, Kontrolle von
Kältezittern bei therapeutischer Hypothermie und schweres ARDS mit hohem Atemantrieb.
Abstract
The management of sedation in intensive care medicine has changed substantially in
the last few years. Neuromuscular blocking agents (NMBA) are only rarely indicated
in modern intensive care medicine. In this review, the mechanism of action, potential
side effects, and special considerations for the application of NMBA to critically
ill patients will be discussed. We further present the rationale for the use of NMBA
for the remaining indications, such as endotracheal intubation, selected cases of
severe acute respiratory distress syndrome, and shivering during temperature control
after cardiac arrest. The review will close with a description of potential side effects
of NMBA use in the intensive care setting, such as awareness, acquired skeletal muscle
weakness as well as corneal injuries, and how monitoring of sedation and peripheral
muscle blockade may be handled.
Schlüsselwörter
Muskelrelaxation - Intensivmedizin - Atemwegsmanagement - ARDS - Critical-Illness-Myopathie
Keywords
neuromuscular blocking agents - intensive care medicine - airway management - ARDS
- critical illness myopathie
