Lesser J B, Koorn R, Vloka J D, Kuroda M M, Thys D M
Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center, New York, NY 10019, USA.
Acta Anaesthesiol Scand. 1999 Nov;43(10):989-98. doi: 10.1034/j.1399-6576.1999.431004.x.
Many studies demonstrate an association between brain damage and the extracellular release of catecholamines and amino acids during cerebral ischemia. While the clinical value of hypothermia during periods of compromised cerebral blood flow and oxygen delivery is well established, the role of anesthetic agents is less clear. Furthermore, the interaction between these agents and hypothermia remains to be elucidated. The purpose of this study was to examine the interactive effects of temperature, sodium thiopental (STP) and etomidate (ETOM) on extracellular neurotransmitter accumulation in the rat corpus striatum during cerebral ischemia.
Animals were randomly assigned to one of six subgroups: normal saline (NS-norm, pericranial t approximately equal to 37 degrees C, and NS-hypo, t=30 degrees C), etomidate (ETOM-norm and ETOM-hypo), and sodium thiopental (STP-norm and STP-hypo). Microdialysis probes were inserted into the corpus striatum. Dopamine (DA), glutamate, 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) levels were measured. At zero minutes, animals received a 10-min infusion of STP (3 mg x kg(-1) x min(-1)), ETOM (0.6 mg x kg(-1) x min(-1)), or NS. Prior to ischemia, animals were given either intravenous STP (10 mg x kg(-1)), ETOM (3 mg x kg(-1)), or NS in bolus form. Each animal was then subjected to 10 min of forebrain ischemia (Is1) followed by a reperfusion interval (Rep1). The entire sequence was then repeated.
There were significant interactions between temperature and drug for DA (Is1, P=0.006, Is2, P=0.032) and its metabolites (DOPAC, Is1 P=0.01, HVA, Is1 P=0.03), and for glutamate (Is1, P=0.03, Is2 P=0.06). The nature of this interaction differed for DA and glutamate. The reduction in DA accumulation seen during hypothermia was offset by the addition of either STP or ETOM, whereas the addition of these drugs did not affect the reduced glutamate levels seen with hypothermia. During normothermia, STP and ETOM resulted in diminished DA accumulation compared to controls, yet they increased the accumulation of extracellular glutamate.
Consistent with other studies, hypothermia was associated with diminished extracellular DA concentrations during forebrain ischemia. However, depending on the temperature condition, the addition of STP or ETOM in our forebrain ischemia model led to unexpected findings. The administration of these agents during normothermia diminished ischemia-induced DA accumulation yet resulted in significantly higher concentrations of extracellular glutamate. In contrast, STP and ETOM during hypothermia were noted to significantly offset the DA-reducing effects of hypothermia.
许多研究表明,脑缺血期间脑损伤与儿茶酚胺和氨基酸的细胞外释放之间存在关联。虽然在脑血流量和氧输送受损期间低温的临床价值已得到充分证实,但麻醉剂的作用尚不清楚。此外,这些药物与低温之间的相互作用仍有待阐明。本研究的目的是探讨温度、硫喷妥钠(STP)和依托咪酯(ETOM)对大鼠脑缺血期间纹状体细胞外神经递质积累的交互作用。
将动物随机分为六个亚组之一:生理盐水(NS-正常体温,颅周温度约为37℃,NS-低温,t = 30℃)、依托咪酯(ETOM-正常体温和ETOM-低温)和硫喷妥钠(STP-正常体温和STP-低温)。将微透析探针插入纹状体。测量多巴胺(DA)、谷氨酸、3,4-二羟基苯乙酸(DOPAC)和高香草酸(HVA)水平。在0分钟时,动物接受10分钟的STP(3mg·kg⁻¹·min⁻¹)、ETOM(0.6mg·kg⁻¹·min⁻¹)或生理盐水输注。在缺血前,动物以推注形式给予静脉注射STP(10mg·kg⁻¹)、ETOM(3mg·kg⁻¹)或生理盐水。然后每只动物进行10分钟的前脑缺血(Is1),随后是再灌注期(Rep1)。然后重复整个序列。
温度和药物之间对DA(Is1,P = 0.006,Is2,P = 0.032)及其代谢产物(DOPAC,Is1 P = 0.01,HVA,Is1 P = 0.03)以及谷氨酸(Is1,P = 0.03,Is2 P = 0.06)存在显著交互作用。DA和谷氨酸这种交互作用的性质不同。低温期间观察到的DA积累减少被添加STP或ETOM所抵消,而添加这些药物并不影响低温时观察到的谷氨酸水平降低。在正常体温下,与对照组相比,STP和ETOM导致DA积累减少,但它们增加了细胞外谷氨酸的积累。
与其他研究一致,低温与前脑缺血期间细胞外DA浓度降低有关。然而,根据温度条件,在我们前脑缺血模型中添加STP或ETOM导致了意外发现。在正常体温下给予这些药物减少了缺血诱导的DA积累,但导致细胞外谷氨酸浓度显著升高。相比之下,低温期间的STP和ETOM被注意到显著抵消了低温对DA的降低作用。