Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.
Anesthesiology. 2013 Sep;119(3):562-8. doi: 10.1097/ALN.0b013e318295a27b.
Inhalational anesthetic effects on upper airway muscle activity in children are largely unknown. The authors tested the hypothesis that phasic inspiratory genioglossus and palatoglossus activity increases during recovery from sevoflurane anesthesia in a dose-dependent manner in children.
Sixteen children, aged 2.0 to 6.9 yr, scheduled for elective urological surgery were studied. Electromyogram recordings were acquired using intramuscular needle electrodes during spontaneous ventilation. After a 15-min period of equilibration, electromyogram activity was recorded over 30 s at each of three end-tidal concentrations, 1.5, 1.0, and 0.5 minimum alveolar concentration (MAC), administered in sequence.
Phasic genioglossus activity was noted in four children at 1.5 MAC, five at 1.0 MAC, and six children at 0.5 MAC sevoflurane. Phasic palatoglossus activity was noted in 4 children at 1.5 MAC, 6 at 1.0 MAC, and 10 children at 0.5 MAC sevoflurane. Both the proportion of children exhibiting phasic activity, and the magnitude of phasic activity increased during recovery from anesthesia. For the genioglossus, decreasing the depth of sevoflurane anesthesia from 1.5 to 1.0 MAC increased phasic activity by approximately 35% and a further decrease to 0.5 MAC more than doubled activity (median [range] at 1.5 and 0.5 MAC: 2.7 μV [0 to 4.0 μV] and 8.6 μV [3.2 to 17.6], respectively; P = 0.029). A similar dose-related increase was recorded at the palatoglossus (P = 0.0002).
Genioglossus and palatoglossus activity increases during recovery from sevoflurane anesthesia in a dose-dependent manner over the clinical range of sevoflurane concentrations in children.
吸入麻醉对上气道肌肉活动的影响在儿童中还知之甚少。作者通过使用肌内针电极进行检测，验证了在七氟醚麻醉恢复过程中，儿童的相吸气颏舌肌和腭舌肌活动随剂量呈依赖性增加的假设。
16 名年龄在 2.0 至 6.9 岁之间的择期泌尿外科手术患儿参与了该研究。在自主通气期间，通过肌内针电极进行肌电图记录。在平衡 15 分钟后，以 1.5、1.0 和 0.5 最小肺泡浓度（MAC）的三个呼气末浓度依次给药，在每个浓度下记录 30 秒的肌电图活动。
在 1.5 MAC 时，4 名儿童出现颏舌肌相活动，在 1.0 MAC 时，5 名儿童出现颏舌肌相活动，在 0.5 MAC 时，6 名儿童出现颏舌肌相活动。在 1.5 MAC 时，4 名儿童出现腭舌肌相活动，在 1.0 MAC 时，6 名儿童出现腭舌肌相活动，在 0.5 MAC 时，10 名儿童出现腭舌肌相活动。在麻醉恢复过程中，出现相活动的儿童比例以及相活动的幅度均增加。对于颏舌肌，从 1.5 MAC 降低七氟醚麻醉深度至 1.0 MAC 可使相活动增加约 35%，进一步降低至 0.5 MAC 可使活动增加一倍以上（1.5 和 0.5 MAC 时的中位数[范围]：2.7 μV[0 至 4.0 μV]和 8.6 μV[3.2 至 17.6]；P = 0.029）。腭舌肌也记录到类似的剂量相关增加（P = 0.0002）。
在七氟醚麻醉恢复过程中，儿童在临床七氟醚浓度范围内，颏舌肌和腭舌肌活动呈剂量依赖性增加。
