Kurita T, Morita K, Kazama T, Sato S
Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan.
Br J Anaesth. 2003 Dec;91(6):871-7. doi: 10.1093/bja/aeg259.
There have been few studies comparing the response to asphyxia and the effectiveness of typical cardiopulmonary resuscitation (CPR) using exogenous epinephrine administration and manual closed-chest compression between total intravenous anaesthesia (TIVA) and inhalational anaesthesia.
Twenty pigs were randomly assigned to two study groups anaesthetized using either 2% end-tidal isoflurane (n=10) or propofol (12 mg x kg(-1) h(-1))-fentanyl (50 microg x kg(-1)) (n=10). Asphyxia was induced by clamping the tracheal tube until the mean arterial pressure (MAP) decreased to 40% of the baseline value (40% MAP time). The tracheal tube was declamped at that point, and CPR was performed. Haemodynamic parameters and blood samples were obtained before the induction of asphyxia, at 1-min intervals during asphyxia, and 1, 2, 3, 5, 10, 30 and 60 min after asphyxia.
TIVA maintained the MAP against hypoxia-hypercapnia stress significantly longer than isoflurane anaesthesia (mean (SD) 40% MAP time 498 (95) and 378 (104) s respectively). In all animals in the isoflurane group, spontaneous circulation returned within 1 min of the start of CPR. In six of the TIVA animals, spontaneous circulation returned for 220 (121) s; spontaneous circulation did not return within 5 min in the remaining four animals.
Although TIVA is less prone than isoflurane anaesthesia to primary cardiovascular depression leading to asphyxia, TIVA is associated with reduced effectiveness of CPR in which resuscitation because of asphyxic haemodynamic depression occurs.
很少有研究比较全静脉麻醉（TIVA）和吸入麻醉时，使用外源性肾上腺素给药及手动胸外按压对窒息的反应以及典型心肺复苏（CPR）的有效性。
将20头猪随机分为两个研究组，分别使用2%的呼气末异氟烷（n = 10）或丙泊酚（12 mg·kg⁻¹·h⁻¹）-芬太尼（50 μg·kg⁻¹）（n = 10）进行麻醉。通过夹闭气管导管诱导窒息，直至平均动脉压（MAP）降至基线值的40%（40% MAP时间）。此时松开气管导管并进行心肺复苏。在窒息诱导前、窒息期间每隔1分钟以及窒息后1、2、3、5、10、30和60分钟获取血流动力学参数和血样。
TIVA维持MAP对抗缺氧 - 高碳酸血症应激的时间明显长于异氟烷麻醉（平均（标准差）40% MAP时间分别为498（95）秒和378（104）秒）。异氟烷组的所有动物在心肺复苏开始后1分钟内恢复自主循环。TIVA组的6只动物恢复自主循环220（121）秒；其余4只动物在5分钟内未恢复自主循环。
虽然TIVA比异氟烷麻醉更不易导致因原发性心血管抑制而引起窒息，但TIVA与心肺复苏有效性降低有关，在因窒息性血流动力学抑制而进行复苏时出现这种情况。
