Muskelrelaxanzien in der Intensivmedizin

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.

Kernaussagen

• In der Intensivmedizin sind Muskelrelaxanzien nur in Einzelfällen indiziert.

• Bei ARDS kann eine kontinuierliche Muskelrelaxation für 24–48 Stunden im Einzelfall erwogen werden. Dies gilt für Erkrankte mit moderatem oder schwerem ARDS, die trotz optimierter Beatmungstherapie mit adäquatem PEEP, Bauchlagerung und optimierter Sedierung eine fortbestehend schwere Oxygenierungsstörung oder eine schädliche Patienten-Ventilator-Asynchronie zeigen.

• Cisatracurium scheint aufgrund seiner pharmakologischen Eigenschaften am besten für eine kontinuierliche Infusion geeignet und hat möglicherweise eigenständig antiinflammatorische Eigenschaften.

• Auf die Vermeidung von Komplikationen durch die Anwendung von Muskelrelaxanzien sollte besonderes Augenmerk gelegt werden.

• Bei der Verwendung von Muskelrelaxanzien muss unbedingt auf eine adäquate Sedierung geachtet werden.

Schlüsselwörter

Muskelrelaxation - Intensivmedizin - Atemwegsmanagement - ARDS - Critical-Illness-Myopathie

Keywords

neuromuscular blocking agents - intensive care medicine - airway management - ARDS - critical illness myopathie

Publikationsverlauf

Artikel online veröffentlicht:
28. August 2024

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