Ali Zulfiqar, Umamaheswara Rao G S, Jaganath A
Department of Neuroanaesthesia, All India Institute of Medical Sciences, New Delhi, India.
J Clin Monit Comput. 2009 Jun;23(3):157-61. doi: 10.1007/s10877-009-9166-z. Epub 2009 Feb 11.
Profound cardiovascular changes may occur at various stages during a craniotomy. These changes require a detailed haemodynamic analysis including cardiac output. In the present study, we used a monitor based on electrical bioimpedance method for noninvasive cardiac output measurement.
In 17 ASA I and II patients undergoing elective craniotomies for supratentorial tumours, the following haemodynamic parameters were measured noninvasively: heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR). Haemodynamic changes in response to the following events were studied: (a) induction of anaesthesia with thiopentone, (b) 15 min of air-O(2)-isoflurane anaesthesia, (c) infiltration of the scalp with lidocaine adrenaline mixture, and (d) change of inspired gas mixture to N(2)O-O(2)-isoflurane.
HR increased (P < 0.001) and SV decreased (P < 0.001) while CO remained unchanged, one min after administration of thiopentone. After 15 min of isoflurane anaesthesia, HR increased (P < 0.001) and, SBP (P = 0.02), DBP (P = 0.002) and SV (P = 0.003) decreased significantly without change in CO. Three minutes after infiltration of the scalp with lidocaine-adrenaline mixture, there was an increase in SBP (P = 0.001), DBP (P = 0.007), SV (P = 0.007) and CO (P = 0.001) and a decrease in SVR (P < 0.001). Addition of nitrous oxide (60%) to the inspired gas mixture decreased SBP (P = 0.003) and DBP (P = 0.001) with a trend for decrease in CO (P < 0.1). The changes recorded in the present study conform to those that have been documented earlier by using invasive monitoring.
Bioimpedance plethysmography is a useful noninvasive technique for monitoring and detailed analysis of the rapidly changing systemic haemodynamics during a craniotomy. The device could be useful for investigating important haemodynamic changes in specific neurosurgical settings.
开颅手术的各个阶段可能会发生显著的心血管变化。这些变化需要进行包括心输出量在内的详细血流动力学分析。在本研究中，我们使用基于生物电阻抗法的监测仪进行无创心输出量测量。
对17例接受幕上肿瘤择期开颅手术的美国麻醉医师协会（ASA）I级和II级患者，无创测量以下血流动力学参数：心率（HR）、收缩压（SBP）、舒张压（DBP）、每搏输出量（SV）、心输出量（CO）和全身血管阻力（SVR）。研究了对以下事件的血流动力学变化：（a）用硫喷妥钠诱导麻醉，（b）15分钟的空气 - 氧气 - 异氟烷麻醉，（c）用利多卡因肾上腺素混合液浸润头皮，以及（d）将吸入气体混合物改为氧化亚氮 - 氧气 - 异氟烷。
给予硫喷妥钠1分钟后，HR升高（P < 0.001），SV降低（P < 0.001），而CO保持不变。异氟烷麻醉15分钟后，HR升高（P < 0.001），SBP（P = 0.02）、DBP（P = 0.002）和SV（P = 0.003）显著降低，CO无变化。用利多卡因 - 肾上腺素混合液浸润头皮3分钟后，SBP（P = 0.001）、DBP（P = 0.007）、SV（P = 0.007）和CO（P = 0.001）升高，SVR降低（P < 0.001）。在吸入气体混合物中添加氧化亚氮（60%）使SBP（P = 0.003）和DBP（P = 0.001）降低，CO有降低趋势（P < 0.1）。本研究记录的变化与先前使用侵入性监测记录的变化一致。
生物电阻抗体积描记法是一种用于监测和详细分析开颅手术期间快速变化的全身血流动力学的有用无创技术。该设备可用于研究特定神经外科手术环境中的重要血流动力学变化。
