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七氟醚对丙泊酚/N₂O麻醉期间脑电双频指数、局部脑氧饱和度及丙泊酚浓度的影响。

The influence of sevoflurane on the bispectral index, regional cerebral oxygen saturation, and propofol concentration during propofol/N2O anesthesia.

作者信息

Nishikawa Koichi, Kanemaru Yoshinori, Hagiwara Ryuji, Goto Fumio

机构信息

Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi City, 371-8511, Japan.

出版信息

J Clin Monit Comput. 2006 Dec;20(6):415-20. doi: 10.1007/s10877-006-9048-6. Epub 2006 Sep 28.

Abstract

OBJECTIVE

This study was undertaken to investigate the influence of sevoflurane on the bispectral index (BIS), regional cerebral oxygen saturation (rSO(2)), and serum propofol concentration during propofol/N(2)O anesthesia. This study tested the hypothesis that sevoflurane affect BIS values, rSO(2), and the pharmacokinetics of propofol during propofol/ N(2)O anesthesia.

METHODS

General anesthesia was administered to 15 ASA I-II patients with a continuous infusion of propofol to maintain a BIS value of 45 +/- 5. After recording baseline values, patients were assigned to receive sevoflurane (2.0%, 20 min). BIS values, rSO(2) using near-infrared spectroscopy, and hemodynamic parameters were recorded for 60 min. Cardiac output (CO) and stroke volume (SV) were evaluated using impedance cardiograph methods. Propofol concentration was determined using high-performance liquid chromatography.

RESULTS

Sevoflurane (2.0%, 20 min) decreased the BIS score from 47.4 +/- 8.2 to 27.3 +/- 5.9 (P < 0.01, n = 15) without affecting rSO(2). Sevoflurane decreased systolic blood pressure from 112.1 +/- 14.0 mmHg to 96.5 +/- 13.2 mmHg (P < 0.001, n = 15) without affecting heart rate. Both CO and SV were significantly decreased during sevoflurane application. Propofol concentration was increased from 2.71 +/- 0.51 microg/ml to 3.30 +/- 0.57 microg/ml (P < 0.05) after sevoflurane application, and was returned to baseline after sevoflurane washout.

CONCLUSIONS

We have shown that sevoflurane decreases BIS values during propofol/N(2)O anesthesia without affecting rSO(2) and that this change is accompanied by an increase in serum propofol concentration. Changes in propofol concentration may be due to, at least in part, hemodynamic changes such as decreased CO produced by sevoflurane.

摘要

目的

本研究旨在探讨七氟醚对丙泊酚/氧化亚氮麻醉期间脑电双频指数(BIS)、局部脑氧饱和度(rSO₂)及血清丙泊酚浓度的影响。本研究检验了如下假设:在丙泊酚/氧化亚氮麻醉期间,七氟醚会影响BIS值、rSO₂以及丙泊酚的药代动力学。

方法

对15例美国麻醉医师协会(ASA)分级为I-II级的患者实施全身麻醉,持续输注丙泊酚以维持BIS值在45±5。记录基线值后,患者被分配接受七氟醚(2.0%,20分钟)。记录60分钟内的BIS值、使用近红外光谱法测得的rSO₂以及血流动力学参数。使用阻抗心动图法评估心输出量(CO)和每搏输出量(SV)。采用高效液相色谱法测定丙泊酚浓度。

结果

七氟醚(2.0%)持续20分钟使BIS评分从47.4±8.2降至27.3±5.9(P<0.01,n = 15),而不影响rSO₂。七氟醚使收缩压从112.1±14.0 mmHg降至96.5±13.2 mmHg(P<0.001,n = 15),但不影响心率。在应用七氟醚期间,CO和SV均显著降低。应用七氟醚后,丙泊酚浓度从2.71±0.51μg/ml升至3.30±0.57μg/ml(P<0.05),七氟醚清除后恢复至基线水平。

结论

我们已经表明,在丙泊酚/氧化亚氮麻醉期间,七氟醚降低BIS值而不影响rSO₂,且这种变化伴随着血清丙泊酚浓度的升高。丙泊酚浓度的变化可能至少部分归因于血流动力学变化,如七氟醚导致的CO降低。

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