Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
Korean J Anesthesiol. 2019 Jun;72(3):260-264. doi: 10.4097/kja.d.18.00244. Epub 2018 Nov 27.
Hypercapnia causes dilation of cerebral vessels and increases cerebral blood flow, resulting in increased intracranial pressure. Sevoflurane is reported to preserve cerebrovascular carbon dioxide reactivity. However, the contribution of inhaled anesthetics to vasodilatory responses to hypercapnia has not been clarified. Moreover, the cerebrovascular response to desflurane under hypercapnia has not been reported. We examined the effects of sevoflurane and desflurane on vasodilatory responses to hypercapnia in rats.
A closed cranial window preparation was used to measure the changes in pial vessel diameters. To evaluate the cerebrovascular response to hypercapnia and/or inhaled anesthetics, the pial vessel diameters were measured in the following states: without inhaled anesthetics at normocapnia (control values) and hypercapnia, with inhaled end-tidal minimal alveolar concentration (MAC) of 0.5 or 1.0 of either sevoflurane or desflurane at normocapnia, and an MAC of 1.0 of sevoflurane or desflurane at hypercapnia.
Under normocapnia, 1.0 MAC, but not 0.5 MAC, of sevoflurane or desflurane dilated the pial arterioles and venules. In addition, under both 1.0 MAC of sevoflurane and 1.0 MAC of desflurane, hypercapnia significantly dilated the pial arterioles and venules in comparison to their diameters without inhaled anesthetics. The degrees of vasodilation were similar for desflurane and sevoflurane under both normocapnia and hypercapnia.
Desflurane induces cerebrovascular responses similar to those of sevoflurane. Desflurane can be used as safely as sevoflurane in neurosurgical anesthesia.
高碳酸血症会导致脑血管扩张并增加脑血流,从而导致颅内压升高。七氟醚被报道能保持脑血管对二氧化碳的反应性。然而,吸入麻醉药对高碳酸血症引起的血管扩张反应的贡献尚未阐明。此外,尚无关于在高碳酸血症下使用地氟醚的脑血管反应的报道。我们检查了七氟醚和地氟醚对大鼠高碳酸血症血管扩张反应的影响。
使用封闭颅窗准备来测量脑膜血管直径的变化。为了评估高碳酸血症和/或吸入麻醉剂对脑血管的反应,在以下状态下测量脑膜血管直径:在正常碳酸血症(对照值)和高碳酸血症下没有吸入麻醉剂,在正常碳酸血症下吸入七氟醚或地氟醚的终末呼气最低肺泡浓度(MAC)为 0.5 或 1.0,以及在高碳酸血症下吸入七氟醚或地氟醚的 MAC 为 1.0。
在正常碳酸血症下,1.0 MAC 的七氟醚或地氟醚扩张了脑膜动静脉,但 0.5 MAC 的七氟醚或地氟醚则没有。此外,在 1.0 MAC 的七氟醚和 1.0 MAC 的地氟醚下,与没有吸入麻醉剂时相比,高碳酸血症均显著扩张了脑膜动静脉。在正常碳酸血症和高碳酸血症下,地氟醚和七氟醚的血管扩张程度相似。
地氟醚诱导的脑血管反应与七氟醚相似。在神经外科麻醉中,地氟醚可与七氟醚一样安全使用。