Propofol up2date – Teil 2: Patientengruppen, unerwünschte Wirkungen und die Nachfolgesubstanz Fospropofol

Zusammenfassung

Propofol ist das am weitesten verbreitete Hypnotikum in der Anästhesiologie und Intensivmedizin und wird auch durch andere Disziplinen für die Sedierung im Rahmen diagnostischer und interventioneller Eingriffe eingesetzt. Trotz seiner Verbreitung sind den Anwendern nicht immer alle pharmakokinetischen und -dynamischen Eigenschaften, Nebenwirkungen und Kontraindikationen dieser facettenreichen Substanz präsent und bezüglich einiger Anwendungsbereiche bestehen Kontroversen und teilweise ungerechtfertigte Vorbehalte. Propofol ist ein hochpotentes Hypnotikum mit einer Vielzahl an (un)erwünschten Nebenwirkungen.

Abstract

Propofol is a common hypnotic agent in anaesthesiology and intensive care medicine and for procedural sedation as well. Despite the intensive usage the full potential, pharmacokinetic and –dynamic abilities, interactions and side effects of the substance may not be realized by all providers. Additionally there is dispute and unwarranted myth about the substance. Propofol is a highly potent hypnotic with a wide range of (un)desired effects. This article is reviewing the diversity of the substance in clinical practice.

Kernaussagen

• Propofol ist bei Kindern < 1 Lebensmonat nicht zugelassen.

• Propofol ist zur langfristigen Sedierung von Patienten < 16 Jahren nicht zugelassen.

• Bei Schwangeren besitzt Propofol tokolytische Eigenschaften. Bei einer Sectio caesarea sollte Propofol aus mehreren Gründen nicht eingesetzt werden.

• Bei Leber- und Niereninsuffizienzpatienten kann Propofol verwendet werden. Bei anhepatischen Patienten ist eine deutliche Dosisreduktion vorzunehmen.

• Der genaue Stellenwert von Propofol bei septischen Patienten ist nicht geklärt.

• Propofol sollte bei Patienten mit Schock nicht verwendet werden.

• Das PRIS ist eine seltene, aber häufig letale Komplikation. Es tritt v. a. im jungen Alter und bei schwerer Grunderkrankung auf.

• Der Injektionsschmerz auf Propofol kann durch vorherige Opioidgabe und Gabe von i.v.-Lidocain in Torniquet-Technik meist vermieden werden.

• Fospropfol ist eine in den USA zur Sedierung zugelassene Prodrug von Propofol.

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