Gazelius B, Stånge K, Lind G, Meyerson B A, Linderoth B
Department of Neurosurgery, Karolinska Institutet/Hospital, Stockholm, Sweden.
Acta Neurochir (Wien). 2002 Jun;144(6):589-94; discussion 594. doi: 10.1007/s007010200079.
During endoscopic transthoracic sympathicotomy (ETS) in patients with hyperhidrosis it is useful to assess the effect of surgery peroperatively. However, the autonomic system is affected in various ways by different anesthetic agents. In the present study, the effect of ETS during either isoflurane or propofol anesthesia was evaluated by measuring changes in the finger pulp microcirculation using laser Doppler flowmetry (LDF). Electric stimulation of the sympathetic chain was used for identifying the sympathetic chain and to explore whether the anesthetic agents differentially influenced the LDF response to stimulation.
From a group of 12 patients with incapacitating palmar hyperhidrosis, six were randomly assigned to isoflurane and six to propofol anesthesia. LDF probes were attached to the ipsilateral finger pulp for continuous recording of peripheral blood flow during the ETS procedure. Electric stimulation (1 Hz, 10 Hz, and 100 Hz) was applied to the sympathetic paravertebral chain at the levels of the 2nd and 3rd sympathetic ganglia via a custom designed bipolar electrode. In eight of the patients LDF recordings were also performed in the awake state and compared with records obtained from eight healthy subjects.
In patients anesthetized with isoflurane, the base line finger pulp blood flow did not significantly differ from that of awake normal subjects, while those anesthetized with propofol had a lower base line flow, similar to that of awake subjects with hyperhidrosis. Stimulation of the sympathetic chain induced marked reduction of finger pulp microcirculation in both anesthetic groups, and this effect was frequency dependent during isoflurane anesthesia. After ETS a significant increase in flow was recorded only in the propofol group. Interpretation. The study demonstrates that the completeness of the sympathicotomy can only be peroperatively evaluated if an anesthetic agent with relatively low vasodilatory capacity, as e.g. propofol, is utilized.
对于多汗症患者，在内镜下经胸交感神经切断术（ETS）期间进行术中手术效果评估很有必要。然而，自主神经系统会受到不同麻醉剂的多种影响。在本研究中，通过使用激光多普勒血流仪（LDF）测量指腹微循环的变化，评估了异氟烷或丙泊酚麻醉期间ETS的效果。交感神经链的电刺激用于识别交感神经链，并探讨麻醉剂是否会对LDF刺激反应产生不同影响。
从12例严重手掌多汗症患者中，随机将6例分配至异氟烷麻醉组，6例分配至丙泊酚麻醉组。在ETS手术过程中，将LDF探头附着于同侧指腹，以连续记录外周血流。通过定制的双极电极，在第2和第3交感神经节水平对交感神经旁链施加电刺激（1Hz、10Hz和100Hz）。8例患者在清醒状态下也进行了LDF记录，并与8例健康受试者的记录进行比较。
异氟烷麻醉的患者，指腹血流基线与清醒正常受试者无显著差异，而丙泊酚麻醉的患者基线血流较低，与清醒多汗症受试者相似。交感神经链刺激在两组麻醉中均引起指腹微循环显著减少，且在异氟烷麻醉期间这种效应具有频率依赖性。ETS术后，仅丙泊酚组记录到血流显著增加。解读：该研究表明，只有使用血管舒张能力相对较低的麻醉剂（如丙泊酚），才能在术中评估交感神经切断术的完整性。
