Kwon Youngsuk, Jang Ji Su, Hwang Sung Mi, Lee Jae Jun, Lee Jun Ho, Joo Sungmin, Lee In-Gon, Hong Sung Jun
Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University college of Medicine, 77 Sakju-ro, Chuncheon, 24253, South Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Scared Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea.
Eur Arch Otorhinolaryngol. 2017 Sep;274(9):3527-3532. doi: 10.1007/s00405-017-4592-x. Epub 2017 Apr 29.
The aim of this study is to determine the range of S-100β levels during functional endoscopic sinus surgery (FESS) when the mean arterial pressure (MAP) was controlled within 60-70 mmHg. After anesthesia induction with propofol and remifentanil, the patient was positioned in the reverse Trendelenburg position and MAP was controlled within 60-70 mmHg during surgery. For the S-100β assay, blood was taken from a radial arterial catheter before (baseline) and at 20 (T ) and 60 (T ) min after setting the reverse Trendelenburg position and controlled hypotension, and at 60 (T ) min after the end of the operation. In total, 34 patients completed the study. Baseline S-100β was 0.00837 ± 0.00785 ng/mL. The levels at T and T were 0.02057 ± 0.01739 and 0.01987 ± 0.01145 ng/mL, respectively. The level of T was 0.05436 ± 0.02318 ng/mL. The level at T increased significantly versus the baseline level (P < 0.001); there were no significant differences between T and T . The level at T was significantly different versus T and T (P < 0.001). However, all S-100β levels were within the normal range. S-100β-a sensitive biomarker of cerebral ischemia-was within the normal range during FESS when moderate hypotension (MAP >60 mmHg) was provided. Thus, moderate hypotension would be seemed to be a safe and effective anesthetic technique for FESS without risk for cerebral ischemia.
本研究的目的是确定在功能性鼻内镜鼻窦手术(FESS)期间,当平均动脉压(MAP)控制在60 - 70 mmHg时S-100β水平的变化范围。在用丙泊酚和瑞芬太尼诱导麻醉后,患者取头高脚低位,手术期间MAP控制在60 - 70 mmHg。对于S-100β检测,在设置头高脚低位和控制性低血压前(基线)、设置后20分钟(T₂₀)和60分钟(T₆₀)以及手术结束后60分钟(T₆₀术后)从桡动脉导管取血。共有34例患者完成了本研究。基线S-100β为0.00837 ± 0.00785 ng/mL。T₂₀和T₆₀时的水平分别为0.02057 ± 0.01739和0.01987 ± 0.01145 ng/mL。T₆₀术后的水平为0.05436 ± 0.02318 ng/mL。T₂₀时的水平与基线水平相比显著升高(P < 0.001);T₂₀和T₆₀之间无显著差异。T₆₀术后的水平与T₂₀和T₆₀相比有显著差异(P < 0.001)。然而,所有S-100β水平均在正常范围内。S-100β是脑缺血的敏感生物标志物,在FESS期间提供适度低血压(MAP > 60 mmHg)时其处于正常范围内。因此,适度低血压似乎是一种用于FESS的安全有效的麻醉技术,无脑缺血风险。