Zwanzig Jahre Levosimendan

Zusammenfassung

Vasopressoren kommen besonders in kritischen, nicht selten lebensbedrohlichen Situationen der Anästhesie, Notfall- und Intensivmedizin zum Einsatz. Die Wahl der geeigneten Substanz sowie die Erkennung und Beherrschung möglicher Nebenwirkungen sind von großer Bedeutung. Im folgenden Beitrag sollen daher die klinisch wichtigsten Substanzen vorgestellt und deren pharmakologische Charakteristika beleuchtet werden.

Abstract

Levosimendan is a calcium sensitizer and opens adenosine triphosphate-dependent potassium channels. Since 20 years, it is approved for acute decompensated heart failure. It has been tested in many clinical trials for treatment of at-risk patients in cardiac surgery, right ventricular failure, pulmonary hypertension, weaning of extracorporeal systems, cardiogenic shock, septic shock, ARDS and others.

Levosimendan has diverse positive effects next to positive inotropy. It improves ventriculoarterial coupling, increases peripheral perfusion, increases kidney glomerular filtration rate, coronary blood flow and it reduces preload and afterload as well as pulmonary capillary wedge pressure.

Due to the opening of potassium channels, it also acts on mitochondria resulting in organ protection. Levosimendan acts anti-apoptotic. These positive effects were described in many small studies. Although this sounds like a promising drug for a variety of settings, results of several multicentre randomized placebo-controlled studies were frustrating. This review resumes some facts of levosimendan in different diseases.

Kernaussagen

• Levosimendan wird empfohlen für Patienten mit akuter Herzinsuffizienz bei Hypotension und Hypoperfusion.

• Levosimendan hat keine Indikation beim septischen Schock.

• Die repetitive Gabe von Levosimendan bei der terminalen Herzinsuffizienz zeigt einen verbesserten Krankheitsverlauf. Dies konnte jedoch in Studien noch nicht belegt werden.

• Die Bolusinjektion von Levosimendan kann eine langanhaltende Hypotonie herbeiführen und sollte streng abgewogen werden.

• Levosimendan könnte bei Patienten mit eingeschränkter EF nach Bypassoperation ohne Klappenintervention von Vorteil sein.

Schlüsselwörter

Levosimendan - Herzinsuffizienz - Kardiochirurgie - Inotropie - Sepsis

Key words

levosimendan - heart failure - cardiac surgery - inotropy - sepsis

Publikationsverlauf

Artikel online veröffentlicht:
29. Juni 2021

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