Fujita Y, Kimura K, Hamada H, Takaori M
Department of Anesthesiology, Kawasaki Medical School, Okayama, Japan.
Anesthesiology. 1991 Aug;75(2):313-8. doi: 10.1097/00000542-199108000-00020.
Recently, there has been increasing interest in the alterations in splanchnic and hepatic circulation and preservation of hepatic oxygenation and function during anesthesia and surgery. However, the effects of volatile anesthetics under a condition of marginal hepatic oxygen supply are not well understood. Using a crossover design, we therefore studied the effects of equianesthetic concentrations (1.5 MAC) of halothane, isoflurane, and sevoflurane on hepatic oxygenation and function in nine beagles in which the hepatic artery had been ligated. Portal blood flow was measured by an electro-magnetic flow meter. Hepatic function was assessed by indocyanine green elimination kinetics. While cardiac output and mean arterial pressure were greater during halothane anesthesia than during isoflurane and sevoflurane anesthesia, portal blood flow and hepatic oxygen supply were significantly less during halothane and sevoflurane anesthesia than during isoflurane anesthesia. With regard to hepatic oxygen uptake, there was a significant difference between halothane (2.7 +/- 1.2 ml.min-1 x 100 g-1) and sevoflurane (3.7 +/- 2.0 ml.min-1 x 100 g-1; P less than 0.05). Consequently, the hepatic oxygen supply/uptake ratio and the hemoglobin oxygen saturation and oxygen partial pressure in hepatic venous blood during sevoflurane anesthesia were significantly less than they were with the other anesthetics. Indocyanine green clearance was better preserved during sevoflurane anesthesia (39.7 +/- 12.0 ml.min-1) than during halothane anesthesia (30.9 +/- 8.4 ml.min-1; P less than 0.05). We conclude that sevoflurane is accompanied by a smaller oxygen supply/uptake ratio than is halothane and isoflurane, while it preserves hepatic function.(ABSTRACT TRUNCATED AT 250 WORDS)
近年来,人们对麻醉和手术期间内脏及肝脏循环的改变以及肝脏氧合和功能的维持越来越感兴趣。然而,在肝脏氧供处于临界状态时挥发性麻醉剂的作用尚不清楚。因此,我们采用交叉设计,研究了在九条肝动脉已结扎的比格犬中,等效麻醉浓度(1.5MAC)的氟烷、异氟烷和七氟烷对肝脏氧合和功能的影响。门静脉血流通过电磁流量计测量。肝功能通过吲哚菁绿清除动力学进行评估。虽然氟烷麻醉期间的心输出量和平均动脉压高于异氟烷和七氟烷麻醉期间,但氟烷和七氟烷麻醉期间的门静脉血流和肝脏氧供明显低于异氟烷麻醉期间。关于肝脏氧摄取,氟烷(2.7±1.2ml·min-1×100g-1)和七氟烷(3.7±2.0ml·min-1×100g-1;P<0.05)之间存在显著差异。因此,七氟烷麻醉期间的肝脏氧供/摄取比以及肝静脉血中的血红蛋白氧饱和度和氧分压明显低于其他麻醉剂。七氟烷麻醉期间吲哚菁绿清除率(39.7±12.0ml·min-1)比氟烷麻醉期间(30.9±8.4ml·min-1;P<0.05)保存得更好。我们得出结论,与氟烷和异氟烷相比,七氟烷的氧供/摄取比更小,同时能维持肝脏功能。(摘要截选至250字)