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DOI: 10.1055/s-2001-17672
Lokalanästhetika und bronchiale Hyperreagibilität
Local Anesthetics and Bronchial HyperreactivityPublikationsverlauf
Publikationsdatum:
05. Oktober 2001 (online)
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Zusammenfassung.
Patienten mit bronchialer Hyperreagibilität haben ein erhöhtes Risiko eines Bronchospasmus bei Manipulation ihrer Atemwege im Rahmen einer In- oder Extubation sowie Bronchoskopie, so dass eine Prophylaxe sinnvoll ist. Die Wirksamkeit der Prophylaxe einer Reflexbronchokonstriktion ist sowohl für inhalativ und intravenös appliziertes Lidocain auch für das β2- Mimetikum Salbutamol als Aerosol nachgewiesen. Beide erhöhen die Histaminschwelle um mehr als das doppelte (2,2- bzw. 2,6-fach) und sind damit ähnlich effektiv. Darüber hinaus hat die kombinierte Applikation von Lidocain und Salbutamol einen additiven Effekt auf die Histaminschwelle (Anhebung auf das 4,8 fache). Der Einsatz von Lidocain ist demnach auch bei Patienten von Nutzen, die wegen einer Atemwegserkrankung mit β2-Mimetika therapiert werden. Inhalativ und intravenös appliziertes Lidocain ist bei unterschiedlich hohen Plasmakonzentrationen wirksam, nämlich nach Inhalation bei 0,7 µg/ml, nach intravenöser Gabe bei ca. 2 µg/ml. Die Inhalation hat den Vorteil der niedrigeren Plasmakonzentration, als Nachteil oft eine initiale Bronchokonstriktion sowie eine Sensibilitätsstörung im Pharynx und Larynx. Demgegenüber ist die intravenöse Applikation einfach, führt aber zu höheren Plasmakonzentrationen mit häufigeren systemischen Nebenwirkungen. Zur Wirksamkeit von Lokalanästhetika in der Therapie von Bronchospasmen liegen dagegen bislang keine kontrollierten Studien vor. Insgesamt bereichert die prophylaktische Anwendung von Lokalanästhetika bei Patienten mit vermuteter oder nachgewiesener bronchialer Hyperreagibilität das Spektrum der perioperativen Pharmakotherapie.
Local Anesthetics and Bronchial Hyperreactivity.
Patients with bronchial hyperreactivity are at increased risk for bronchospasm particularly during airway instrumentation such as with intubation, extubation, or bronchoscopy. Pretreatment with either lidocaine or salbutamol is suggested, since application of lidocaine intravenously or salbutamol as an aerosol has been shown to be similarly effective in increasing the (2,2 resp. 2,6 fold) threshold for histamine evoked bronchoconstriction. Furthermore, combined salbutamol and lidocaine pretreatment has an additive effect and increases 4,8 fold the histamine-threshold. Thus, lidocaine treatment can be applied to patients with airway disease treated with β2-mimetics also. Inhaled and injected lidocaine is equally effective in decreasing histamine threshold although at different plasma concentrations, i. e., lidocaine is effective at approx. 0,7 µg/ml after inhalation but at up to 2 µg/ml after injection. While inhaled lidocaine results in lower plasma concentrations it can evoke an initial bronchoconstriction. Furthermore, local anesthesia of pharynx and larynx associated with inhalation may not be tolerable in some patients. Intravenous lidocaine, in contrast, results in higher plasma concentrations and side-effects are seen more often. While several case reports have described beneficial effects of lidocaine in the treatment of bronchospasm no clinical studies have been performed. Overall, both inhaled and injected local anesthetics are effective in mitigating reflex mediated bronchoconstriction.
Schlüsselwörter:
Bronchiale Hyperreagibilität - Lokalanästhetika - Lidocain - Salbutamol
Key words:
Airways - Bronchial hyperreactivity - Bronchospasm - Local anesthetics - Lidocaine - Salbutamol
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Prof. Dr. med. J. Peters
Abteilung für Anästhesiologie und Intensivmedizin
Universitätsklinikum Essen
Hufelandstraße 55
45122 Essen
eMail: juergen.peters@uni-essen.de