Newman B, Gelb A W, Lam A M
Anesthesiology. 1986 Mar;64(3):307-10. doi: 10.1097/00000542-198603000-00001.
Deliberate hypotension was induced with isoflurane (mean inspired concentration 2.3 +/- 1.0%) in 12 patients undergoing craniotomy for clipping of cerebral aneurysms. Global cerebral blood flow (CBF) was measured before, during, and after hypotension. Arterio-venous O2 content difference was measured concomitantly, and the cerebral metabolic rate for oxygen (CMRO2) was calculated from these data. Mean arterial pressure (MAP) was reduced from 78 +/- 5 mmHg to 51 +/- 7 mmHg and then returned to 82 +/- 8 mmHg. Mean CBF before hypotension was 49 +/- 14 ml X 100 g-1 X min-1 and was unchanged during (45 +/- 12 ml X 100 g-1 X min-1) and after (49 +/- 15 ml X 100 g-1 X min-1) hypotension. The CMRO2 before hypotension was 2.0 +/- 0.6 ml X 100 g-1 X min-1. This was statistically significantly (P less than 0.025) reduced to 1.5 +/- 0.5 ml X 100 g-1 X min-1 during hypotension and then returned to 2.2 +/- 0.6 ml X 100 g-1 X min-1 on return to normotension. This indicates that the global cerebral O2 supply-demand balance was favorably influenced by isoflurane. No complications could be attributed to the hypotensive technique. We conclude that, with regard to global cerebral oxygenation, isoflurane is a safe agent with which to induce hypotension during neurosurgery.
对12例因脑动脉瘤夹闭术而接受开颅手术的患者，使用异氟烷（平均吸入浓度2.3±1.0%）诱导控制性低血压。在低血压之前、期间和之后测量全脑血流量（CBF）。同时测量动静脉氧含量差，并根据这些数据计算脑氧代谢率（CMRO2）。平均动脉压（MAP）从78±5 mmHg降至51±7 mmHg，然后恢复至82±8 mmHg。低血压前平均CBF为49±14 ml·100 g-1·min-1，在低血压期间（45±12 ml·100 g-1·min-1）和之后（49±15 ml·100 g-1·min-1）保持不变。低血压前CMRO2为2.0±0.6 ml·100 g-1·min-1。在低血压期间，该值显著降低（P<0.025）至1.5±0.5 ml·100 g-1·min-1，恢复至正常血压后又回到2.2±0.6 ml·100 g-1·min-1。这表明异氟烷对全脑氧供需平衡有有利影响。未发现任何并发症可归因于低血压技术。我们得出结论，就全脑氧合而言，异氟烷是神经外科手术中诱导低血压的一种安全药物。
