Zusammenfassung.
Seit über 100 Jahren untersuchen Wissenschaftler die Funktion des sympathischen Nervensystems,
des wichtigsten physiologischen Kreislaufkontrollsystems. Die Muskelsympathikusaktivität
in Ruhe und ihre reflektorische Aktivitätszunahme durch Kreislaufstressoren stellt
dabei die wesentliche Variable zur Beurteilung von Anästhetika-Effekten beim Menschen
dar. Die vorliegende Übersichtsarbeit stellt die Kenntnisse im Hinblick auf das sympathische
Nervensystem zusammen und betrachtet die Wirkungen von Injektions- und Inhalationsanästhetika
auf den Muskelsympathikus. Die Anästhetika Etomidate und Ketamin sowie eine Inhalationsanästhesie
mit niedrig dosiertem Isofluran, Stickoxydul und Opioiden beeinträchtigen sympathische
Kreislaufregulationsmechanismen am geringsten und sind damit unter hämodynamischen
Gesichtspunkten für die Aufrechterhaltung eines ausreichenden arteriellen Blutdruckes
insbesondere bei Patienten mit bereits aktivierten sympathischen Kompensationsmechanismen
empfehlenswert.
Sympathetic Control Mechanisms During General Anesthesia.
For more than 100 years scientists have studied the sympathetic nervous system and
its cardiovascular control mechanisms. Muscle sympathetic activity is the most important
direct and rapidly responding variable for evaluation of sympathetic neural outflow.
Therefore, anesthesiologists have been interested in the effects of anesthetics on
muscle sympathetic activity at rest and during cardiovascular challenges. This review
summarizes effects of positive pressure ventilation, intravenous and inhalational
anesthetics as well as nitrous oxide on sympathetic muscle outflow. The least depression
of both resting sympathetic outflow and its response to challenges is observed following
administration of etomidate, ketamine, or a combination of low dose isoflurane/nitrous
oxide and opioids. Thus, these anesthetics can be recommended for anesthesia in patients
with already activated sympathetic outflow to maintain arterial blood pressure.
Schlüsselwörter:
Allgemeinanästhesie - Sympathisches Nervensystem - Katecholamine - Mikroneurographie
- Muskelsympathikusaktivität - Kreislaufreflexe - Injektionsanästhetika - Stickoxydul
- Inhalationsanästhetika
Key words:
General Anesthesia - Sympathetic Nervous System - Catecholamines - Microneurography
- Muscle Sympathetic Activity - Baroreflex - iv-Anesthetics - Volatile Anesthetics
- Nitrous Oxide
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Dr. med. Peter Kienbaum
Abteilung für Anästhesiologie und Intensivmedizin
Universitätsklinikum Essen
Hufelandstraße 55
45122 Essen
Email: peter.kienbaum@uni-essen.de
