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Herz-Kreislauf-Pharmaka

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Anästhesiologie

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Zusammenfassung

Sympathomimetika sind nach wie vor unentbehrliche Medikamente der Notfallmedizin. Ziel der Behandlung bei Herz- und Kreislaufstillstand, akuter Herzinsuffizienz und bestimmten Schockformen ist die Wiederherstellung einer adäquaten Auswurfleistung des Herzens, eines ausreichenden Perfusionsdrucks oder einer Optimierung des peripheren Gefäßwiderstands. Dabei werden im Myokard vorwiegend β1-adrenerge Rezeptoren, an den Gefäßen dagegen je nach Pharmakon β2-, α1 oder dopaminerge Rezeptoren stimuliert (Abb. 1). Der therapeutische Effekt hängt außer von der Art und Dosierung des Katecholamins von der hämodyna-mischen Ausgangslage sowie von der Zahl und Ansprechbarkeit adrenerger Rezeptoren ab. Bei Erkrankungen, die mit einem hohen Sympathikotonus bzw. erhühten Katecholaminspiegeln im Plasma einhergehen, wie z. B. bei Herzinsuffizienz, konnte eine „down regulation“ der β1-Rezeptoren, d.h. eine verminderte β1 -Rezeptorendichte sowie eine abgeschwächte inotrope Ansprechbarkeit des Myokards auf exogene Katecholamine nachgewiesen werden [9, 29] (Abb. 2). Eine Dauermedikation mit Sympathomimetika (z. B. bei Patienten mit Asthma bronchiale) führt gleichfalls zu einer (selektiven) „down regulation“ β1-adrenerger Rezeptoren [32], wobei jedoch die Funktion myokardialer und vaskulärer α1-Rezeptoren erhalten bleibt [38].

Weitere Informationen zum Thema dieses Kapitels sind in folgenden Kapiteln zu finden: 1.2, 2.9, 4.6, 4.15, 5.2, 5.5, 6.1.

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Editors and Affiliations

  1. Institut für experimentelle Anästhesiologie, Bereich Poliklinik, Ludwig-Maximilians-Universität, Pettenkoferstr. 8a, W-8000, München 2, Deutschland

    Alfred Doenicke

  2. Zentrum Anaesthesiologie, Rettungs-und Intensivmedizin, Universität Göttingen, Robert-Koch-Str. 40, W-3400, Göttingen, Deutschland

    Dietrich Kettler

  3. Universitätsklinik für Anästhesiologie, LKH Graz, Auenbruggerplatz, A-8036, Graz, Österreich

    Werner F. List

  4. Zentrum für Anästhesiologie, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, W-4000, Düsseldorf, Deutschland

    Jörg Tarnow

  5. Institut für Anästhesiologie und Intensivbehandlung, Universität Bern Inselspital, CH-3010, Bern, Schweiz

    Dick Thomson

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© 1992 Springer-Verlag Berlin Heidelberg

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Tarnow, J. (1992). Herz-Kreislauf-Pharmaka. In: Doenicke, A., Kettler, D., List, W.F., Tarnow, J., Thomson, D. (eds) Anästhesiologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-97158-7_9

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  • DOI: https://doi.org/10.1007/978-3-642-97158-7_9

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-97159-4

  • Online ISBN: 978-3-642-97158-7

  • eBook Packages: Springer Book Archive

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