Mühling J, Dehne M G, Sablotzki A, Mühling A, Hempelmann G
Department of Anaesthesiology and Intensive Care Medicine, Justus-Liebig-University, Giessen, Germany.
Eur J Anaesthesiol. 1999 Jun;16(6):380-6. doi: 10.1046/j.1365-2346.1999.00502.x.
The acute influence of therapeutic doses of theophylline on cerebral blood flow velocities during general anaesthesia induced either by halothane or isoflurane has not been elucidated previously. The aim of this study, was therefore to investigate these effects during steady state anaesthetic conditions in anaesthetized patients using transcranial Doppler sonography. Thirty-four Patients were investigated. Anaesthesia was maintained either with 1 MAC (minimum alveolar concentration) halothane (n = 16) or 1 MAC isoflurane (n = 18); FiO2: 40%; end-expiratory pCO2: normocapnia. Theophylline administration was performed before surgery by infusing 6 mg kg-1 over a period of 7.5 min. Measurements were recorded prior to theophylline administration, and immediately after 2 mg kg-1 (2.5 min), 4 mg kg-1 (5 min) and 6 mg kg-1 (7.5 min), as well as 5, 10, 15, 20, 30 and 45 min after theophylline administration. Recorded variables included blood pressure, heart rate, arterial oxygen saturation, end-expiratory pCO2, body temperatures, middle cerebral artery blood flow velocity and pulsatility index. Theophylline administration was well tolerated by all study subjects. Heart rate, blood pressure, body temperatures, arterial oxygen saturation and end-expiratory pCO2 remained constant during the whole examination period. Following theophylline, mean blood flow velocity decreased by 25% in the halothane and by 30% in the isoflurane group (P < 0.05). By the end of the examination period, mean blood flow velocity had not yet recovered to the initial values whereby in both groups the mean blood flow velocity was 26% below the initial values. In the isoflurane group, the pulsatility index increased by about 20% (P < 0.05) and remained high until the end of the examination. In the halothane group, however, there were no changes in the pulsatility index. Our results show a remarkable, significant and simultaneous decrease in blood flow velocity in the middle cerebral artery associated with theophylline administration during halothane and isoflurane anaesthesia in man.
以往尚未阐明治疗剂量的茶碱对氟烷或异氟烷诱导的全身麻醉期间脑血流速度的急性影响。因此，本研究的目的是使用经颅多普勒超声检查，在麻醉患者的稳态麻醉条件下研究这些影响。对34例患者进行了研究。麻醉维持采用1MAC（最低肺泡浓度）氟烷（n = 16）或1MAC异氟烷（n = 18）；FiO2：40%；呼气末pCO2：正常碳酸血症。手术前通过在7.5分钟内输注6mg/kg给予茶碱。在给予茶碱前、给予2mg/kg（2.5分钟）、4mg/kg（5分钟）和6mg/kg（7.5分钟）后立即记录测量值，以及在给予茶碱后5、10、15、20、30和45分钟记录测量值。记录的变量包括血压、心率、动脉血氧饱和度、呼气末pCO2、体温、大脑中动脉血流速度和搏动指数。所有研究对象对给予茶碱耐受性良好。在整个检查期间，心率、血压、体温、动脉血氧饱和度和呼气末pCO2保持恒定。给予茶碱后，氟烷组平均血流速度降低25%，异氟烷组降低30%（P < 0.05）。到检查期结束时，平均血流速度尚未恢复到初始值，两组的平均血流速度均比初始值低26%。在异氟烷组中，搏动指数增加约20%（P < 0.05），并一直保持到检查结束时仍较高。然而，在氟烷组中，搏动指数没有变化。我们的结果表明，在人体氟烷和异氟烷麻醉期间，给予茶碱会使大脑中动脉血流速度显著、明显且同时降低。
