Dumps C, Bolkenius D, Halbeck E
Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Stenglinstr. 2, 85156, Augsburg, Deutschland.
Anaesthesist. 2017 Dec;66(12):969-980. doi: 10.1007/s00101-017-0381-6.
The pharmacological and historical knowledge about the currently available intravenous induction hypnotics form the basis for the daily work of anesthetists. Side effects of using hypnotic induction agents must be anticipated and adequately treated. Decades of experience with using intravenous induction hypnotics have led to theoretical requirements for an ideal narcotic agent with a best possible side effect profile. In the absence of this optimal hypnotic induction agent, a careful selection of one or a combination of narcotic drugs is necessary to meet the needs of the respective risk constellation of the patient. While propofol enjoyed increasing frequency of use over the last three decades and is currently regarded as the gold standard in numerous clinics, thiopental is a noteworthy alternative apart from its elimination kinetics. Furthermore, substances with favorable hemodynamic profiles are available with etomidate and ketamine. Midazolam as a short-acting benzodiazepine rounds off the spectrum.
目前可用的静脉诱导催眠药的药理学和历史知识构成了麻醉医生日常工作的基础。必须预见并妥善处理使用催眠诱导剂的副作用。数十年来使用静脉诱导催眠药的经验催生了对具有尽可能最佳副作用特征的理想麻醉剂的理论要求。在没有这种最佳催眠诱导剂的情况下,必须仔细选择一种或多种麻醉药物的组合,以满足患者各自风险情况的需求。在过去三十年中,丙泊酚的使用频率不断增加,目前在众多诊所被视为金标准,而硫喷妥钠除了其消除动力学外,也是一种值得注意的替代品。此外,依托咪酯和氯胺酮具有良好的血流动力学特征。咪达唑仑作为一种短效苯二氮䓬完善了这一药物种类。