Dexmedetomidin in der Intensivmedizin

Kernaussagen

α₂-Agonisten spielen heute eine wichtige Rolle in der Anästhesie und Intensivmedizin. Bei sachgemäßem Einsatz sind die Nebenwirkungen substanzspezifisch und vorhersehbar. Die Kombination aus sedierenden und analgetischen Eigenschaften bei gleichzeitig fehlender Atemdepression und einer Glättung der hämodynamischen Schwankungen durch sympatholytische Eigenschaften weisen auf die günstigen Wirkungen dieser Substanzklasse hin. Überdies induziert Dexmedetomidin eine einzigartige, dem natürlichen Schlaf ähnliche Sedierung und kann die Delir-Prävalenz beatmeter Patienten reduzieren.

Dexmedetomidin ist zugelassen zur Sedierung erwachsener Intensivpatienten, die eine Sedierungstiefe benötigen, welche ein Erwecken durch verbale Stimulation noch erlaubt (RASS 0 bis –3). Anders als Clonidin, das bisher meist primär als Adjuvans eingesetzt wird und keine Zulassung als Monosedativum hat, kann man Dexmedetomidin in solchen Situationen daher als primäres Sedativum verwenden – ergänzt durch Analgetika und ggf. zusätzliche Sedativa.

Die spezifischen Anwendungsgebiete bei kritisch kranken Intensivpatienten unter Berücksichtigung der Grunderkrankung müssen sicher noch durch weitere Untersuchungen und Erfahrungen in der klinischen Praxis genauer definiert werden. Ebenso muss sich zeigen, ob die bisher in Studien gefundenen günstigen Effekte bezüglich der Delirhäufigkeit und der Reduktion der Beatmungsdauer bestätigt werden können [10] [39] [40]. Nach bisherigen Daten kann Dexmedetomidin potenziell eine wichtige Bereicherung des pharmakologischen Armamentariums in der Anästhesie und Intensivmedizin sein. Weitere Untersuchungen sind aber notwendig, um abschließend eine Nutzen-Risiko-Analyse vornehmen zu können.

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