Rozet Irene
Department of Anesthesiology, Harborview Medical Center, Seattle, Washington 98104, USA.
Curr Opin Anaesthesiol. 2008 Oct;21(5):537-43. doi: 10.1097/ACO.0b013e32830edafd.
The purpose of this review is to summarize current approaches to the anesthetic management of functional neurosurgery and to describe the application of an alpha-2-adrenergic agonist dexmedetomidine in the anesthetic management of functional neurosurgical procedures.
Dexmedetomidine, an alpha-2-adrenergic agonist, causes a unique kind of sedation, acting on the subcortical areas, which resembles natural sleep without respiratory depression. Experimental data demonstrate both cerebral vasoconstriction and vasodilatation, depending on the model and dose studied. At the clinically relevant doses, dexmedetomidine decreases cerebral blood flow and cerebral metabolic rate of oxygen in healthy volunteers. Clinical experience of dexmedetomidine use in functional neurosurgery is limited to small case-series. Nevertheless, these reports indicate that use of dexmedetomidine does not interfere with electrophysiologic monitoring, thus allowing brain mapping during awake craniotomy and microelectrode recording during implantation of deep-brain stimulators.
Dexmedetomidine has been demonstrated to provide a successful sedation without impairment of electrophysiologic monitoring in functional neurosurgery. Prospective randomized studies are warranted to delineate an optimal regimen of dexmedetomidine sedation and any dose-related influence on neurophysiologic function.
本综述旨在总结功能性神经外科手术麻醉管理的当前方法，并描述α2肾上腺素能激动剂右美托咪定在功能性神经外科手术麻醉管理中的应用。
右美托咪定是一种α2肾上腺素能激动剂，可产生独特的镇静作用，作用于皮层下区域，类似于自然睡眠且无呼吸抑制。实验数据表明，根据所研究的模型和剂量不同，右美托咪定既有脑血管收缩作用，也有脑血管舒张作用。在临床相关剂量下，右美托咪定可降低健康志愿者的脑血流量和脑氧代谢率。右美托咪定在功能性神经外科手术中的临床应用经验仅限于小病例系列。然而，这些报告表明，使用右美托咪定不会干扰电生理监测，从而在清醒开颅手术期间允许进行脑图谱绘制，并在植入脑深部刺激器期间进行微电极记录。
已证明右美托咪定在功能性神经外科手术中可提供成功的镇静且不损害电生理监测。有必要进行前瞻性随机研究，以确定右美托咪定镇静的最佳方案以及对神经生理功能的任何剂量相关影响。
