Harborview Medical Center, University Washington, Seattle, WA 98104-2499, USA.
Curr Opin Anaesthesiol. 2009 Oct;22(5):547-52. doi: 10.1097/ACO.0b013e32833020be.
This review will examine the recent literature on anesthesia and monitoring techniques in relation to cerebral autoregulation. We will discuss the effect of physiologic and pharmacological factors on cerebral autoregulation alongside its clinical relevance with the help of new evidence.
Intravenous anesthesia, such as combination of propofol and remifentanil, provides best preservation of autoregulation. Among inhaled agents sevoflurane appears to preserve autoregulation at all doses, whereas with other agents autoregulation is impaired in a dose-related manner.
Intraoperative cerebral autoregulation monitoring is an important consideration for the patients with neurologic disease. Transcranial Doppler based static autoregulation measurements appears to be the most robust bedside method for this purpose.
本文将回顾近期有关麻醉和监测技术与脑自动调节的文献。我们将结合新的证据，讨论生理和药理因素对脑自动调节的影响及其临床意义。
静脉麻醉，如丙泊酚和瑞芬太尼的联合使用，可最好地维持自动调节。在吸入性药物中，七氟醚在所有剂量下似乎都能维持自动调节，而其他药物则以剂量相关的方式损害自动调节。
术中脑自动调节监测是神经疾病患者的一个重要考虑因素。基于经颅多普勒的静态自动调节测量似乎是最可靠的床边方法。
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