TITLE

Ischämische Komplikationen in der Neurochirurgie

AUTHOR(S)
M. J. Merkel; A. M. Brambrink
PUB. DATE
August 2008
SOURCE
Anaesthesist;Aug2008, Vol. 57 Issue 8, p794
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Zusammenfassung  Die Dysregulation des zellulären Kalziumhaushalts spielt eine zentrale Rolle in der „ischämischen Kaskade“ und bei der Entwicklung eines zerebralen Vasospasmus nach Subarachnoidalblutung (SAB). Daher erscheint eine therapeutische, oder wenn möglich, sogar prophylaktische Anwendung von zerebral wirksamen Kalziumkanalblockern bei neurochirurgischen Risikopatienten als attraktive Interventionsmöglichkeit. Die prinzipielle neuroprotektive Wirksamkeit von Kalziumantagonisten ist durch tierexperimentelle Untersuchungen belegt; dennoch sind die bisherigen klinischen Erfahrungen bei Patienten mit vergleichbaren zerebralen Störungen ernüchternd. Ein therapeutischer Effekt ist nur für den Dihydropyridinkalziumkanalblocker Nimodipin (orale Applikation) und nur bei Patienten nach SAB durch kontrollierte Studien gesichert. Experimentelle Daten weisen auf Kalziumkanalblocker anderer Subtypen als erfolgversprechende Kandidaten für eine Neuroprotektion im klinischen Kontext hin. Es ist jedoch auch vorstellbar, dass andere kalziumkanalunabhängige Mechanismen eine weitaus wichtigere pathophysiologische Rolle bei der Entwicklung der neuronalen Schädigung nach Ischämie spielen als bisher angenommen. Der Einsatz von Kalziumkanalblockern zur Prophylaxe ischämischer Komplikationen in der Neurochirurgie kann derzeit also nur für Patienten nach SAB empfohlen werden. Andere potenzielle Indikationen, wie beispielsweise akute zerebrale Ischämie oder Schädelhirntrauma (SHT), sind bis heute nicht durch klinische Evidenz belegt.
ACCESSION #
34010092

 

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