Department of Neuroanesthesia, Center of Functionally Integrative Neuroscience, Arhus University Hospital, Denmark.
Anesthesiology. 2010 Jan;112(1):50-6. doi: 10.1097/ALN.0b013e3181c38bd3.
The regional cerebral blood flow (CBF) response to propofol and indomethacin may be abnormal in patients with brain tumors. First, the authors tested the hypothesis that during propofol anesthesia alone and combined with indomethacin, changes in CBF, cerebral blood volume (CBV), and plasma mean transit time (MTT) differ in the peritumoral tissue compared with the contralateral normal brain region. Second, the authors tested the hypothesis that CBF and CBV are reduced and MTT is prolonged, in both regions during propofol anesthesia and indomethacin administration compared with propofol alone.
The authors studied eight patients subjected to craniotomy under propofol-fentanyl anesthesia for supratentorial brain tumors. Magnetic resonance imaging, including perfusion- and diffusion-weighted and structural sequences, was performed (1) on the day before surgery, (2) before and (3) after administration of indomethacin in the propofol-fentanyl anesthetized patient, and (4) 2 days after surgery. Maps of CBF, CBV, and MTT were calculated. The regions of interest were peritumoral gray matter and opposite contralateral gray matter. Analysis of variance was used to analyze flow data.
Propofol anesthesia was associated with a median 32% (range, 3-61%) and 47% (range, 17-67%) reduction in CBF in the peritumoral and contralateral regions, respectively.The interaction between intervention with propofol and indomethacin and region of interest was not significant for any flow modalities. Neither intervention nor region was significant for MTT, CBF, and CBV (P > 0.05).
The CBF, CBV, and MTT responses to propofol and indomethacin are not different in the peritumoral region compared with contralateral brain tissue. Indomethacin did not further influence regional CBF, CBV, and MTT during propofol anesthesia.
在脑肿瘤患者中，异丙酚和吲哚美辛引起的区域性脑血流（CBF）反应可能异常。首先，作者验证了这样一个假设，即在单独使用异丙酚麻醉以及与吲哚美辛联合使用期间，与对侧正常脑区相比，肿瘤周围组织中的 CBF、脑血容量（CBV）和平均通过时间（MTT）变化不同。其次，作者假设与单独使用异丙酚相比，在异丙酚麻醉和吲哚美辛给药期间，两个区域的 CBF 和 CBV 降低，MTT 延长。
作者研究了 8 例在异丙酚-芬太尼麻醉下接受幕上脑肿瘤切除术的患者。在手术前一天（1）、异丙酚-芬太尼麻醉下患者给予吲哚美辛之前（2）和之后（3）以及手术后 2 天（4）进行磁共振成像，包括灌注和弥散加权及结构序列。计算 CBF、CBV 和 MTT 图。感兴趣区为肿瘤周围灰质和对侧相应灰质。采用方差分析分析流量数据。
异丙酚麻醉与肿瘤周围和对侧区域 CBF 分别减少 32%（范围 3-61%）和 47%（范围 17-67%）相关。干预与异丙酚和吲哚美辛与感兴趣区之间的相互作用对任何血流模式均无显著影响。干预或区域对 MTT、CBF 和 CBV 均无显著影响（P > 0.05）。
与对侧脑组织相比，肿瘤周围区域对异丙酚和吲哚美辛的 CBF、CBV 和 MTT 反应没有差异。吲哚美辛在异丙酚麻醉期间对区域 CBF、CBV 和 MTT 没有进一步影响。
