Kochs E, Nollen H, Schulte am Esch J
Abteilung für Anästhesiologie, Universitäts-Krankenhaus Eppendorf.
Anasth Intensivther Notfallmed. 1990 Oct;25(5):348-53.
It is generally assumed that the brain is not primarily involved in the development of a malignant hyperthermia syndrome (MH). However, spontaneous brain electrical activity (EEG) has not been related temporally to the development of haemodynamic, respiratory and metabolic changes during a fulminant MH crisis. In the present study cerebral blood flow (CBF) and spontaneous electroencephalogram (EEG) were recorded in 8 pigs susceptible (MHS) for the development of malignant hyperthermia and 8 non-susceptible pigs (nMHS) after exposure to 1% halothane. Power densities in selected frequency bands were calculated from the EEG. Additionally, body temperature and haemodynamic and blood gas parameters were studied over a period of 60 min. MH was triggered in all MHS animals. Following exposure to halothane initial EEG changes were noted after 20 to 30 min. They consisted of a decrease in total power and a shift to lower frequencies (delta-theta activity). At this time, CBF was significantly increased compared to control. In 4 animals an isoelectric EEG was noted at a PaO2 of 65-78 mmHg and PaCO2 of 52 to 64 mmHg. Characteristic changes for the development of an MH syndrome in haemodynamic and respiratory parameters as well as a rise in body temperature occurred after first EEG changes were seen. Our results do not support the hypothesis that early EEG changes during MH occur as a result of systemic hypotension, hypoxaemia, hypercapnia or cerebral ischaemia. Our data indicate that EEG monitoring in combination with monitoring of haemodynamic, respiratory and metabolic parameters may be of value for an early detection of an MH-crisis.
一般认为,大脑并非恶性高热综合征(MH)发生发展的主要影响因素。然而,在暴发性MH危象期间,自发脑电活动(EEG)与血流动力学、呼吸及代谢变化的发生在时间上并无关联。在本研究中,对8头易发生恶性高热的猪(MHS)和8头不易发生恶性高热的猪(nMHS)吸入1%氟烷后记录其脑血流量(CBF)和自发脑电图(EEG)。从EEG计算选定频段的功率密度。此外,在60分钟内研究体温、血流动力学和血气参数。所有MHS动物均引发了MH。吸入氟烷后,20至30分钟后出现初始EEG变化。表现为总功率降低并向低频(δ-θ活动)转移。此时,与对照组相比,CBF显著增加。在4只动物中,当动脉血氧分压(PaO2)为65 - 78 mmHg且动脉血二氧化碳分压(PaCO2)为52至64 mmHg时记录到脑电静息。在首次观察到EEG变化后,出现了MH综合征在血流动力学和呼吸参数方面的特征性变化以及体温升高。我们的结果不支持以下假说,即MH期间早期EEG变化是由系统性低血压、低氧血症、高碳酸血症或脑缺血所致。我们的数据表明,EEG监测与血流动力学、呼吸和代谢参数监测相结合可能对早期发现MH危象有价值。