Oshiro Alexandre Hideaki, Otsuki Denise Aya, Hamaji Marcelo Waldir M, Rosa Kaleizu T, Ida Keila Kazue, Fantoni Denise T, Auler José Otavio Costa
Programa de Pós-Graduação em Anestesiologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Laboratório de Investigação Médica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Clinics (Sao Paulo). 2015 Dec;70(12):804-9. doi: 10.6061/clinics/2015(12)07.
Inhalant anesthesia induces dose-dependent cardiovascular depression, but whether fluid responsiveness is differentially influenced by the inhalant agent and plasma volemia remains unknown. The aim of this study was to compare the effects of isoflurane, sevoflurane and desflurane on pulse pressure variation and stroke volume variation in pigs undergoing hemorrhage.
Twenty-five pigs were randomly anesthetized with isoflurane, sevoflurane or desflurane. Hemodynamic and echocardiographic data were registered sequentially at minimum alveolar concentrations of 1.00 (M1), 1.25 (M2), and 1.00 (M3). Then, following withdrawal of 30% of the estimated blood volume, these data were registered at a minimum alveolar concentrations of 1.00 (M4) and 1.25 (M5).
The minimum alveolar concentration increase from 1.00 to 1.25 (M2) decreased the cardiac index and increased the central venous pressure, but only modest changes in mean arterial pressure, pulse pressure variation and stroke volume variation were observed in all groups from M1 to M2. A significant decrease in mean arterial pressure was only observed with desflurane. Following blood loss (M4), pulse pressure variation, stroke volume variation and central venous pressure increased (p < 0.001) and mean arterial pressure decreased in all groups. Under hypovolemia, the cardiac index decreased with the increase of anesthesia depth in a similar manner in all groups.
The effects of desflurane, sevoflurane and isoflurane on pulse pressure variation and stroke volume variation were not different during normovolemia or hypovolemia.
吸入麻醉会引起剂量依赖性心血管抑制，但吸入麻醉剂和血浆容量是否对液体反应性有不同影响尚不清楚。本研究的目的是比较异氟烷、七氟烷和地氟烷对出血猪脉搏压变异和每搏量变异的影响。
25头猪随机用异氟烷、七氟烷或地氟烷麻醉。在最低肺泡浓度1.00（M1）、1.25（M2）和1.00（M3）时依次记录血流动力学和超声心动图数据。然后，在抽取估计血容量的30%后，在最低肺泡浓度1.00（M4）和1.25（M5）时记录这些数据。
最低肺泡浓度从1.00增加到1.25（M2）时，心脏指数降低，中心静脉压升高，但从M1到M2，所有组的平均动脉压、脉搏压变异和每搏量变异仅出现适度变化。仅地氟烷组观察到平均动脉压显著降低。失血后（M4），所有组的脉搏压变异、每搏量变异和中心静脉压升高（p<0.001），平均动脉压降低。在低血容量状态下，所有组的心脏指数均随着麻醉深度的增加以相似方式降低。
在血容量正常或低血容量状态下，地氟烷、七氟烷和异氟烷对脉搏压变异和每搏量变异的影响无差异。
