Remifentanil up2date – Teil 2

Zusammenfassung

Remifentanil wird seit 20 Jahren mit Erfolg in vielen Bereichen der Anästhesiologie eingesetzt. Im 1. Teil wurde die Substanz mit ihren pharmakologischen Charakteristika sowie ihren erwünschten und unerwünschten Wirkungen beschrieben. Der hier vorliegende 2. Teil befasst sich mit der Anwendung des Opioids bei speziellen Patientengruppen und in den verschiedenen anästhesiologisch betreuten Fachdisziplinen.

Abstract

Remifentanil is a short-acting opioid of high analgetic potency and superior controllability. It is widely used in day-case surgery, procedural sedation, for reduction of recovery-times and obstetrics and whenever excellent controllability of opioid effects is needed. Especially in combination with propofol it is used for target controlled infusion (TCI). The second part of the article shows the differences between groups of patients regarding the use of remifentanil.

Kernaussagen

• Remifentanil ist mittlerweile seit 20 Jahren im klinischen Einsatz. Die pharmakokinetischen und pharmakodynamischen Eigenschaften zeichnen die gute Steuerbarkeit des Medikaments aus.

• Vor allem die kurze kontextsensitive Eingriffszeit führt dazu, dass die Substanz in der Neonatologie, der Prozeduralsedierung, in der Elektrokrampftherapie und neuerdings in der Geburtshilfe unter entsprechenden Sicherheitsmaßnahmen eingesetzt wird.

• In anderen Bereichen wie der Notfallmedizin und der Endoskopie konnte sich Remifentanil bisher nicht nachhaltig durchsetzen.

• In der Versorgung von chronischen Schmerzpatienten und Patienten mit Abhängigkeiten kann es von großem Vorteil sein, muss jedoch teilweise sehr hoch dosiert werden.

• Zu den Nachteilen des Pharmakons zählen typische Opioideffekte, wie Atemdepression, Bradykardien und Thoraxrigidität sowie die kontrovers diskutierte opioidinduzierte Hyperalgesie (OIH).

• Remifentanil ist zusammen mit Propofol in der Hand des geübten Anästhesisten ein wertvolles und sicheres Medikament, das vor allem in der ambulanten Anästhesiologie „nahezu unverzichtbar“ ist.

• Aus diesem Grund trifft die seit 2016 bestehende eingeschränkte Verfügbarkeit und Kontingentierung der Substanz in Deutschland vor allem diesen Zweig der Anästhesiologie hart.

Schlüsselwörter

Remifentanil - Einsatz bei Patientengruppen - Nebenwirkungen - Schmerz

Key words

remifentanil - usage in groups of patients - side effects - pain

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