Pharmakokinetik bei Neugeborenen und Säuglingen*

A. Röper; P. M. Lauven

doi:10.1055/s-1999-216

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Anästhesiol Intensivmed Notfallmed Schmerzther 1999; 34(10): 616-625
DOI: 10.1055/s-1999-216

ÜBERSICHT

Georg Thieme Verlag Stuttgart · New York

Pharmakokinetik bei Neugeborenen und Säuglingen*

Pharmacokinetics in Neonates and Infants.A. Röper, P. M. Lauven

Klinik für Anästhesie und operative Intensivmedizin, Städtische Kliniken Bielefeld gem.GmbH

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Publication History

Publication Date:
31 December 1999 (online)

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Zusammenfassung.

Anatomisch-physiologische Veränderungen von Neugeborenen und Säuglingen können die Pharmakokinetik anästhesierelevanter Medikamente deutlich beeinflussen. Zudem stellt die Neugeborenenphase die Lebensphase mit den schnellsten und ausgeprägtesten Veränderungen bezüglich wichtiger Organfunktionen dar. Änderungen der Körperzusammensetzung und des Proteingehaltes beeinflussen das Verteilungsvolumen, die Distribution zwischen den Kompartimenten und die freie Plasmafraktion einiger Pharmaka wie z. B. Relaxanzien oder Lokalanästhetika. Durch die Unreife hepatischer mikrosomaler Enzymsysteme kommt es zu einer verminderten Metabolisierung v. a. von Substanzen mit einer niedrigen hepatisch-metabolischen Clearance wie beispielsweise Diazepam, Morphin oder einige Lokalanästhetika. Die Entwicklung der Enzymsysteme im ersten Lebensjahr führt zu einer Steigerung der Clearance, die z. T. über das Erwachsenenniveau hinaus geht. Zudem treten Veränderungen der Pharmakodynamik bei diesen Kindern im Sinne einer veränderten Sensibilität gegenüber Pharmaka auf. So nimmt die MAC volatiler Anästhetika mit zunehmendem Alter ab. Da es sich in dieser Altersgruppe um ein sehr heterogenes Patientenklientel mit großen interindividuellen Differenzen handelt, ist eine individuell angepaßte Dosierung erforderlich, um einen optimalen pharmakodynamischen Effekt ohne toxische Nebenwirkungen zu erzielen.

Physiologic changes influence the pharmacokinetics of drugs relevant to anesthesia in neonates and infants. The neonatal phase is the phase of life with the most rapid and dramatic changes of organ-functions responsible for pharmacokinetics of most anesthetics. Changes in body composition and the content of plasma proteins influence volume of distribution, the drug distribution to different compartments and the amount of free fraction in plasma. Due to the immaturity of hepatic microsomal enzyme systems there is a decreased metabolism particular of agents which undergo low hepatic extraction like Diazepam, Morphine or some local anesthetics. In the first year of life capacity of the enzymatic systems increases and also clearance increases. Until puberty the clearance of some drugs is greater than the adult level. There are also pharmacodynamic changes like modified sensitivity to some drugs like volatile anesthetics or neuromuscular blocking agents. In summary neonates and infants are a highly heterogenous group with large interindividual differences. Therefore the dosage of anesthetic agents must be individualized to achieve optimal pharmacodynamic effects without toxicity in this age group.

Schlüsselwörter:

Pharmakokinetik - Neugeborene & - Säuglinge - Pädiatrische Anästhesie - Pharmakodynamik

Key words:

Pharmacokinetics - Neonates - Infants - Pediatric anesthesia - Pharmacodynamics

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Dr. A. Röper

Klinik für Anästhesie und operative Intensivmedizin Städtische Kliniken Bielefeld gem.GmbH

Teutoburger Straße 50

33604 Bielefeld

Email: roeper@sk-bielefeld.de