Riedijk Maaike A, Milstein Dan M J
Department of Pediatric Intensive Care, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Department of Oral & Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Microcirculation. 2018 Aug;25(6):e12484. doi: 10.1111/micc.12484. Epub 2018 Jul 15.
Procedural sedation with propofol is widely used in the pediatric population. A well-known side effect of propofol is a decrease in peripheral vascular resistance resulting in hypotension, but little is known about the effects on microcirculation in humans. We aimed to evaluate the effects of propofol on the sublingual microcirculatory perfusion by continuous video imaging in pediatric patients undergoing procedural sedation.
Patients admitted to the Pediatric Intensive Care Unit for procedural sedation were recruited. Oral microcirculation was measured employing a continuous monitoring strategy with incident dark-field illumination imaging. Measurements were obtained before and 3 minutes after propofol induction. Total and perfused vessel densities, proportion of perfused vessels, microvascular flow index, blood vessel diameter (Ø ), and systemic hemodynamics were analyzed.
Continuous measurements were achieved in seven patients. Three minutes after propofol induction mean arterial pressure decreased (P = 0.028) and total and perfused vessel densities increased by 12% (P = 0.018) and 16% (P = 0.018), respectively. MFI was unaltered and mean Ø increased but not significantly.
Propofol induction induces a reduction in mean arterial pressure and a rise in sublingual microvascular perfusion. The observed effects of propofol on the sublingual microcirculation may be due to a decrease in microvascular resistance.
丙泊酚用于小儿程序性镇静已广泛应用。丙泊酚一个众所周知的副作用是外周血管阻力降低导致低血压，但对人体微循环的影响知之甚少。我们旨在通过连续视频成像评估丙泊酚对接受程序性镇静的儿科患者舌下微循环灌注的影响。
招募入住儿科重症监护病房接受程序性镇静的患者。采用入射暗场照明成像的连续监测策略测量口腔微循环。在丙泊酚诱导前和诱导后3分钟进行测量。分析总血管密度和灌注血管密度、灌注血管比例、微血管血流指数、血管直径（Ø）和全身血流动力学。
7例患者实现了连续测量。丙泊酚诱导后3分钟，平均动脉压下降（P = 0.028），总血管密度和灌注血管密度分别增加12%（P = 0.018）和16%（P = 0.018）。微血管血流指数未改变，平均Ø增加但不显著。
丙泊酚诱导导致平均动脉压降低和舌下微血管灌注增加。丙泊酚对舌下微循环的观察到的影响可能是由于微血管阻力降低。
