Shirasawa Yumiko, Matsumoto Mishiya, Yoshimura Manabu, Yamashita Atsuo, Fukuda Shiro, Ishida Kazuyoshi, Sakabe Takefumi
Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, 755-8505, Japan.
J Anesth. 2009;23(2):242-8. doi: 10.1007/s00540-009-0741-8. Epub 2009 May 15.
Intrathecal morphine given during a post-ischemic period has been reported to have the potential to exacerbate ischemic spinal cord injury. However, it remains unknown whether synthetic opioids administered systemically exacerbate ischemic injury. We sought to compare the damage of the spinal cord after transient spinal cord ischemia in rabbits anesthetized with three different regimens; isoflurane, fentanyl with isoflurane, and remifentanil with isoflurane.
We assigned rabbits to three groups (n = 9 in each); an isoflurane group (isoflurane 1 minimum alveolar concentration [MAC]), a fentanyl group (isoflurane 0.5 MAC + 100 microg x kg(-1) i.v. fentanyl given over 30 min before aortic occlusion), and a remifentanil group (isoflurane 0.5 MAC + 1 microg x kg(-1) x min(-1) i.v. remifentanil started 30 min before aortic occlusion and maintained until 1 h after reperfusion). Spinal cord ischemia was produced by occluding the abdominal aorta for 13 min. Hindlimb motor function (score range: 4, normal to 0, paraplegia) was assessed daily for 7 days, and then the number of normal neurons in the anterior spinal cord was counted.
Severe motor dysfunction (score < or = 1) was observed in seven, four, and five animals in the isoflurane, fentanyl, and remifentanil groups, respectively. There were no significant intergroup differences in neurological scores. There were no differences in the numbers of normal neurons among the three groups (22 +/- 22, 42 +/- 30, 33 +/- 28, respectively).
Our results suggest that neither i.v. fentanyl nor i.v. remifentanil added to 0.5 MAC isoflurane exacerbated ischemic spinal cord injury in rabbits when compared to 1 MAC isoflurane.
据报道，在缺血后阶段给予鞘内吗啡有可能加重缺血性脊髓损伤。然而，全身给予合成阿片类药物是否会加重缺血性损伤仍不清楚。我们试图比较用三种不同方案麻醉的兔短暂脊髓缺血后脊髓的损伤情况；异氟烷、芬太尼复合异氟烷以及瑞芬太尼复合异氟烷。
我们将兔分为三组（每组n = 9）；异氟烷组（异氟烷1最低肺泡浓度[MAC]）、芬太尼组（在主动脉阻断前30分钟静脉给予异氟烷0.5 MAC + 100微克/千克芬太尼，持续30分钟）和瑞芬太尼组（在主动脉阻断前30分钟开始静脉给予异氟烷0.5 MAC + 1微克/千克·分钟瑞芬太尼，并维持至再灌注后1小时）。通过阻断腹主动脉13分钟造成脊髓缺血。每天评估后肢运动功能（评分范围：4，正常至0，截瘫），持续7天，然后计算脊髓前角正常神经元的数量。
异氟烷组、芬太尼组和瑞芬太尼组分别有7只、4只和5只动物出现严重运动功能障碍（评分≤1）。神经学评分在组间无显著差异。三组之间正常神经元数量无差异（分别为22±22、42±30、33±28）。
我们的结果表明，与1 MAC异氟烷相比，在0.5 MAC异氟烷基础上静脉给予芬太尼或瑞芬太尼均未加重兔缺血性脊髓损伤。
