Gordon E, Lagerkranser M, Rudehill A, von Holst H
Department of Anaesthesiology, Karolinska Hospital, Stockholm, Sweden.
Acta Anaesthesiol Scand. 1988 Feb;32(2):108-12. doi: 10.1111/j.1399-6576.1988.tb02696.x.
Ten patients with intracerebral tumours (TC) and 13 patients with subarachnoid haemorrhage (SAH) from a ruptured cerebral arterial aneurysm were studied before intracranial surgery, and during a 3-h postoperative period. Cerebrospinal fluid pressure (CSFP) determined by an intraventricular (TC group) or intraspinal (SAH group) catheter, and mean arterial blood pressure (MABP) were recorded under neurolept anaesthesia (control) followed by isoflurane inhalation. These two measurements were performed during normocapnia. A third measurement was made during hypocapnia, with unchanged isoflurane concentration. After the experimental period, isoflurane remained the main anaesthetic agent throughout the surgical procedure. After recovery from anaesthesia, the patients were monitored with CSFP and blood pressure during the first postoperative hours, and the quality of breathing was assessed by hourly blood-gas analyses. The results show that isoflurane causes a 10-14% reduction of MABP with no further changes during hyperventilation. Mean CSFP increased 27% in the TC group, and 12% in the SAH group after isoflurane induction and decreased from these levels by 29% during hyperventilation in both groups. Consequently, the impact on cerebral perfusion pressure (CPP) by isoflurane was a 19% and 21% mean decrease in the TC and SAH group, respectively. Controlled hyperventilation reduced this effect by partially restoring control CPP values, with 8% and 14% increase, respectively. In the postoperative follow-up, all patients had normal breathing and blood pressure with low values of CSFP. It is concluded that isoflurane can be used in intracranial surgery with adequate safety if combined with controlled hyperventilation.
对10例患有脑肿瘤（TC）的患者和13例因脑动脉动脉瘤破裂导致蛛网膜下腔出血（SAH）的患者，在颅内手术前及术后3小时内进行了研究。通过脑室内导管（TC组）或脊髓内导管（SAH组）测定脑脊液压力（CSFP），并在神经安定麻醉（对照）后吸入异氟烷期间记录平均动脉血压（MABP）。这两项测量在正常碳酸血症期间进行。在异氟烷浓度不变的情况下，于低碳酸血症期间进行第三次测量。实验期结束后，异氟烷在整个手术过程中仍是主要麻醉剂。麻醉恢复后，在术后最初几个小时对患者进行CSFP和血压监测，并通过每小时的血气分析评估呼吸质量。结果表明，异氟烷可使MABP降低10 - 14%，过度通气期间无进一步变化。异氟烷诱导后，TC组平均CSFP升高27%，SAH组升高12%，两组在过度通气期间均从这些水平下降29%。因此，异氟烷对脑灌注压（CPP）的影响在TC组和SAH组中分别平均降低19%和21%。控制性过度通气通过部分恢复控制性CPP值降低了这种影响，分别升高了8%和14%。在术后随访中，所有患者呼吸和血压正常，CSFP值较低。结论是，如果与控制性过度通气相结合，异氟烷可安全用于颅内手术。
