Neudeck Stephan, Kästner Sabine B R, Wittenberg-Voges Liza, Rohn Karl, Hopster Klaus
Am J Vet Res. 2018 May;79(5):487-495. doi: 10.2460/ajvr.79.5.487.
OBJECTIVE To determine global and peripheral perfusion and oxygenation during anesthesia with equipotent doses of desflurane and propofol combined with a constant rate infusion of dexmedetomidine in horses. ANIMALS 6 warmblood horses. PROCEDURES Horses were premedicated with dexmedetomidine (3.5 μg•kg, IV). Anesthesia was induced with propofol or ketamine and maintained with desflurane or propofol (complete crossover design) combined with a constant rate infusion of dexmedetomidine (7 μg•kg •h). Microperfusion and oxygenation of the rectal, oral, and esophageal mucosa were measured before and after sedation and during anesthesia at the minimal alveolar concentration and minimal infusion rate. Heart rate, mean arterial blood pressure, respiratory rate, cardiac output, and blood gas pressures were recorded during anesthesia. RESULTS Mean ± SD minimal alveolar concentration and minimal infusion rate were 2.6 ± 0.9% and 0.04 ± 0.01 mg•kg •min, respectively. Peripheral microperfusion and oxygenation decreased significantly after dexmedetomidine administration for both treatments. Oxygenation returned to baseline values, whereas tissue microperfusion remained low during anesthesia. There were no differences in peripheral tissue microperfusion and oxygenation between treatments. Cardiac index was significantly higher and systemic vascular resistance was significantly lower for desflurane treatment than for propofol treatment. For the propofol treatment, Pao was significantly higher and there was less dead space and venous admixture than for the desflurane treatment. CONCLUSIONS AND CLINICAL RELEVANCE Dexmedetomidine decreased blood flow and oxygen saturation in peripheral tissues. Peripheral tissues were well oxygenated during anesthesia with desflurane and propofol combined with dexmedetomidine, whereas blood flow was reduced.
目的 确定在马中使用等效剂量的地氟烷和丙泊酚联合持续输注右美托咪定麻醉期间的全身和外周灌注及氧合情况。
动物 6 匹温血马。
方法 马用右美托咪定(3.5 μg•kg,静脉注射)进行术前用药。用丙泊酚或氯胺酮诱导麻醉,并用 地氟烷或丙泊酚(完全交叉设计)联合持续输注右美托咪定(7 μg•kg •h)维持麻醉。在镇静前和镇静后以及麻醉期间,于最低肺泡浓度和最低输注速率时测量直肠、口腔和食管黏膜的微灌注和氧合情况。在麻醉期间记录心率、平均动脉血压、呼吸频率、心输出量和血气压力。
结果 平均±标准差最低肺泡浓度和最低输注速率分别为 2.6±0.9%和 0.04±0.01 mg•kg •min。两种治疗方法在给予右美托咪定后外周微灌注和氧合均显著降低。氧合恢复至基线值,而在麻醉期间组织微灌注仍较低。两种治疗方法在外周组织微灌注和氧合方面无差异。地氟烷治疗组的心脏指数显著高于丙泊酚治疗组,全身血管阻力显著低于丙泊酚治疗组。对于丙泊酚治疗组,动脉血氧分压显著更高,死腔和静脉混合比地氟烷治疗组更少。
结论及临床意义 右美托咪定降低外周组织的血流和氧饱和度。在使用地氟烷和丙泊酚联合右美托咪定麻醉期间外周组织氧合良好,而血流减少。