Purrucker J C, Renzland J, Uhlmann L, Bruckner T, Hacke W, Steiner T, Bösel J
Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
Department of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
Br J Anaesth. 2015 Jun;114(6):934-43. doi: 10.1093/bja/aev070. Epub 2015 Mar 29.
The anaesthetic conserving device, AnaConDa(®), allows use of inhaled anaesthetics for sedation in the intensive care unit. We prospectively measured cerebral and cardiopulmonary parameters in patients with acute stroke or subarachnoid haemorrhage during a switch from i.v. to inhalative sedation.
25 patients were switched from i.v. to an indefinite period of inhaled sedation with sevoflurane. Mean arterial (MAP), intracranial (ICP), and cerebral perfusion pressure (CPP), middle cerebral artery mean flow velocity (MFV) and fractional tissue oxygen extraction (FTOE), systemic cardiopulmonary parameters, and administered drugs were assessed before and after the change (-6 to +12 h).
In 8 patients, critically reduced MAP or ICP crisis led to premature termination of sevoflurane sedation. In the other 17 patients, after the first hour, mean ICP increased [2.4 (4.5) mm Hg; P=0.046], MAP decreased [7.8 (14.1) mm Hg; P=0.036] and thus CPP decreased also [-10.2 (15.1) mm Hg; P=0.014]. MFV and FTOE did not change. Over a 12 hour post switch observational period, [Formula: see text] increased slightly [0.3 (0.8) kPa; P=0.104], ICP did not change [0.2 (3.9) mm Hg; P=0.865], but MAP [-6 (6.9) mm Hg; P=0.002] and thus CPP decreased [-6 (8.5) mm Hg; P=0.010].
Sevoflurane led to sufficient sedation, but decreased MAP and CPP in a selected cerebrovascular neurocritical care population. In about a third of these patients, severe adverse reactions, including intolerable ICP increases, were observed.
麻醉保存装置AnaConDa（®）允许在重症监护病房使用吸入性麻醉剂进行镇静。我们前瞻性地测量了急性中风或蛛网膜下腔出血患者从静脉镇静转换为吸入性镇静期间的脑和心肺参数。
25例患者从静脉镇静转换为七氟醚吸入性镇静的不确定时期。在转换前后（-6至+12小时）评估平均动脉压（MAP）、颅内压（ICP）、脑灌注压（CPP）、大脑中动脉平均血流速度（MFV）和组织氧摄取分数（FTOE）、全身心肺参数以及所用药物。
8例患者中，严重降低的MAP或ICP危机导致七氟醚镇静过早终止。在其他17例患者中，第1小时后，平均ICP升高[2.4（4.5）mmHg；P=0.046]，MAP降低[7.8（14.1）mmHg；P=0.036]，因此CPP也降低[-10.2（15.1）mmHg；P=0.014]。MFV和FTOE未改变。在转换后12小时的观察期内，[公式：见正文]略有升高[0.3（0.8）kPa；P=0.104]，ICP未改变[0.2（3.9）mmHg；P=0.865]，但MAP[-6（6.9）mmHg；P=0.002]，因此CPP降低[-6（8.5）mmHg；P=0.010]。
七氟醚可产生足够的镇静效果，但在特定的脑血管神经重症监护人群中会降低MAP和CPP。在这些患者中约三分之一观察到严重不良反应，包括无法耐受的ICP升高。
