Piracetam in der Anästhesie zur Prophylaxe eines postoperativen Delirs

Zusammenfassung.

Das Delir ist eine ernste Komplikation nach operativen Eingriffen mit Allgemeinanästhesie. Seine Häufigkeit wird auf 10 - 15 % geschätzt. Bei zusätzlich bestehenden Risikofaktoren wie hohem Alter, vorbestehender hirnorganischer und psychischer Beeinträchtigung, sowie langer Anästhesiedauer findet sich eine wesentlich höhere Inzidenz. Das Delir beeinträchtigt die postoperative Mobilisierung und Rekonvaleszenz der Patienten, kann den stationären Aufenthalt verlängern und ist mit einer erhöhten Sterblichkeit assoziiert. Eine Prophylaxe ist daher von großem praktischen Interesse. In einer Reihe von klinischen Studien konnte durch perioperative Verabreichung des Nootropikums Piracetam eine verkürzte Aufwachzeit und eine günstige Wirkung auf delirante Symptomatik nachgewiesen werden. Vor allem Patienten mit Risikofaktoren für ein postoperatives Delir profitierten am deutlichsten von der prophylaktischen Behandlung mit Piracetam. Der Behandlungserfolg wird mit einer protektiven Wirkung der Substanz auf zerebrale Nervenzellen gegenüber Hypoxie, Ischämie und Intoxikation erklärt, die als Ursache für das postoperative Delir diskutiert werden. Neben den pathogenetischen Mechanismen des postoperativen Delirs wird die Wirkungsweise von Piracetam in einer Übersicht dargestellt und die Literatur zur klinisch-praktischen Anwendbarkeit der Substanz in der Anästhesie zusammengefaßt.

Schlüsselwörter:

Piracetam #postoperatives Delir #postoperative psychiatrische Störungen

Delirium is a serious postoperative complication after general anaesthesia. The incidence is estimated to be about 10 - 15 %. In the case of additional risk factors, such as old age, previously existing cerebral-vasculous and psychic deficiencies, and anaesthesia of long duration the incidence is much higher. Delirium impairs postoperative mobilisation and convalescence of the patient, can lead to a longer hospital stay and is associated with higher mortality rates. In a series of clinical studies it could be shown that the perioperative administration of the nootropic piracetam led to a shorter recovery period after anaesthesia and had a favourable influence on the delirious symptoms. Especially patients with risk factors for postoperative delirium profited from prophylactic application of piracetam. The success of this medication can be explained by a protective influence of the substance on central neurons against hypoxia, ischemia and intoxication, all of which are discussed as possible causes for postoperative delirium. Next to the pathogenetic mechanisms of postoperative delirium, the mode of action of piracetam is shown in a review and a summary of references on the clinical use in anaesthesia is given.

Key words:

piracetam - postoperative delirium - postoperative psychiatric syndromes

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