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Opioide in der Anästhesie bei Leber- und Niereninsuffizienz

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Zusammenfassung

Die Pharmakokinetik der in Anästhesie und Intensivmedizin verwendeten Opioide ist bei eingeschränkter Leber- und Nierenfunktion verändert. Fentanyl, Sufentanil, Alfentanil und Piritramid unterliegen der hepatischen Metabolisierung, ihre extrahepatische Metabolisierung ist bei Leberfunktionsstörung bedeutsam. Nach Einzeldosen von Fentanyl und Sufentanil ist deren Pharmakokinetik bei Leber- oder Nierenfunktionsstörungen nicht verändert. Dagegen kann die kontinuierliche Gabe von Fentanyl zur Akkumulation und Wirkungsverlängerung bei Niereninsuffizienz führen. Alfentanil hat eine eingeschränkte Clearance und Elimination bei Lebererkrankung und sollte daher bei Leberinsuffizienz vermieden werden. Bei Nierenerkrankungen ist hingegen keine Dosisanpassung von Alfentanil erforderlich. Remifentanil kann bei Leber- und Niereninsuffizienz ohne Dosisanpassung verwendet werden. Die Clearance von Morphin ist bei schweren Lebererkrankungen deutlich reduziert, bei ausgeprägter Nierenfunktionsstörung kommt es zur Akkumulation der Metabolite. Es empfiehlt sich daher der Verzicht der Substanz bei Leber- und Niereninsuffizienz. Piritramid muss bei Leberinsuffizienz dosisangepasst werden.

Abstract

The pharmacokinetics of opioids are impaired in patients with liver and renal failure. Fentanyl, sufentanil, and alfentanil are metabolized in the liver. The extrahepatic metabolism by renal enzymes is gaining more importance in patients with severe liver disease. Pharmacokinetic effects of single doses of fentanyl and sufentanil are not affected in liver and renal failure; however, continuous infusion of fentanyl may result in accumulation and prolonged opioid effects. Plasma clearance and elimination of alfentanil are reduced in patients with liver failure and its clinical use can therefore not be recommended. A reduction in alfentanil dosing is not necessary in patients with renal failure. Remifentanil is the opioid of choice in patients with liver and renal failure. The clearance of morphine is reduced in liver failure. In renal failure an accumulation of morphine metabolites has been demonstrated, and thus, application of morphine is not recommended in patients with liver and renal failure. A reduction in piritramide dosing is necessary in patients with liver failure.

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  1. Klinik für Anästhesiologie und operative Intensivmedizin, Charité, Universitätsmedizin Berlin, Campus Virchow- Klinikum, Berlin

    C. Höhne, B. Donaubauer &  U. Kaisers

  2. Klinik für Anästhesiologie und operative Intensivmedizin, Charité, Campus Virchow-Klinikum, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 , Berlin

    U. Kaisers

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  1. C. Höhne
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Correspondence to U. Kaisers.

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Höhne, C., Donaubauer, B. & Kaisers, U. Opioide in der Anästhesie bei Leber- und Niereninsuffizienz. Anaesthesist 53, 291–305 (2004). https://doi.org/10.1007/s00101-004-0651-y

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