Ceran Canan, Pampal Arzu, Goktas Ozgur, Pampal H Kutluk, Olmez Ercument
Department of Pediatric Surgery, Inonu University, Malatya.
Indian J Urol. 2010 Jul;26(3):364-8. doi: 10.4103/0970-1591.70570.
This study was designed to test the hypothesis that propofol, ketamine, and midazolam could alter the contractile activity of detrusor smooth muscle.
Four detrusor muscle strips isolated from each rat bladder (n = 12) were placed in 4 tissue baths containing Krebs-Henseleit solution. The carbachol (10 (-8)to 10(-4)mol/L)-induced contractile responses as well as 5, 10, 20, 30, 40, 50 Hz electrical field stimulation (EFS)-evoked contractile responses of the detrusor muscles were recorded using isometric contraction measurements. After obtaining basal responses, the in vitro effects of propofol, ketamine, midazolam (10(-5) to 10(-3) mol/L), and saline on the contractile responses of the detrusor muscle strips were recorded and evaluated.
All the 3 drugs reduced the carbachol-induced and/or EFS-evoked contractile responses of rat detrusor smooth muscles in different degrees. Midazolam (10(-4) to 10(-3) mol/L) caused a significant decrease in the contractile responses elicited by either EFS or carbachol (P=0.000-0.013). Propofol (10(-3)mol/L) caused a decrease only in EFS-evoked contractile responses (P=0.001-0.004) and ketamine (10(-3)mol/L) caused a decrease only in carbachol-induced contractile responses (P=0.001-0.034).
We evaluated the effects of the 3 different intravenous anesthetics on detrusor contractile responses in vitro and found that there are possible interactions between anesthetic agents and detrusor contractile activity. The depressant effects of midazolam on the contractile activity were found to be more significant than ketamine and propofol. Despite the necessity of further studies, it could be a piece of wise advice to clinicians to keep the probable alterations due to intravenous anesthetics in mind, while evaluating the results of urodynamic studies in children under sedation.
本研究旨在验证丙泊酚、氯胺酮和咪达唑仑是否会改变逼尿肌平滑肌的收缩活性这一假设。
从每只大鼠膀胱分离出四条逼尿肌条（n = 12），置于含有克雷布斯 - 亨塞尔特溶液的4个组织浴槽中。使用等长收缩测量法记录卡巴胆碱（10（-8）至10（-4）mol/L）诱导的收缩反应以及5、10、20、30、40、50 Hz电场刺激（EFS）诱发的逼尿肌收缩反应。获得基础反应后，记录并评估丙泊酚、氯胺酮、咪达唑仑（10（-5）至10（-3）mol/L）和生理盐水对逼尿肌条收缩反应的体外作用。
这三种药物均不同程度地降低了大鼠逼尿肌平滑肌由卡巴胆碱诱导的和/或EFS诱发的收缩反应。咪达唑仑（10（-4）至10（-3）mol/L）使EFS或卡巴胆碱引发的收缩反应显著降低（P = 0.000 - 0.013）。丙泊酚（10（-3）mol/L）仅使EFS诱发的收缩反应降低（P = 0.001 - 0.004），氯胺酮（10（-3）mol/L）仅使卡巴胆碱诱导的收缩反应降低（P = 0.001 - 0.034）。
我们评估了三种不同静脉麻醉剂对体外逼尿肌收缩反应的影响，发现麻醉剂与逼尿肌收缩活性之间可能存在相互作用。发现咪达唑仑对收缩活性的抑制作用比氯胺酮和丙泊酚更显著。尽管有必要进一步研究，但对于临床医生而言，在评估镇静状态下儿童尿动力学研究结果时，牢记静脉麻醉剂可能引起的改变不失为明智之举。
