Neely K A, Ernest J T, Goldstick T K
Duke University Eye Center, Durham, North Carolina, USA.
Invest Ophthalmol Vis Sci. 1995 Aug;36(9):1943-6.
General anesthesia reduces systemic blood pressure and, thus, ocular perfusion pressure (at constant intraocular pressure). Whether this reduction in ocular perfusion pressure produces retinal hypoxia is unknown. To answer this question, the authors measured inner retinal oxygen tension in cats under general enflurane anesthesia at three clinically relevant levels of anesthesia under normoxic conditions.
Polarographic oxygen microelectrodes were used to measure inner retinal oxygen tension in cats under enflurane anesthesia at 21% inspired oxygen tension. Measurements were made in the preretinal vitreous body within 100 to 200 microns of the internal limiting membrane of the retina. Three levels of enflurane anesthesia were used: 1.2%, 2.4%, and 3.6%, corresponding to 0.5, 1.0, and 1.5 minimal alveolar concentration. Intraocular pressure of the cats was maintained at a constant normal level throughout the experiments.
Under normoxic conditions, inner retinal oxygen tension remained unchanged or increased slightly as ocular perfusion pressure decreased with deeper levels of enflurane anesthesia.
Commonly used surgical levels of enflurane general anesthesia do not cause hypoxia of the inner retina in cats breathing 21% inspired oxygen. This may be the result of preservation of retinal vascular autoregulation under enflurane anesthesia, retinal vasodilatation secondary to a direct smooth muscle relaxing effect of enflurane, or decreased retinal oxygen use under enflurane anesthesia.
全身麻醉会降低体循环血压,从而降低眼灌注压(在眼内压恒定的情况下)。目前尚不清楚这种眼灌注压的降低是否会导致视网膜缺氧。为了回答这个问题,作者在常氧条件下,在三种临床相关的麻醉深度下,测量了氟烷全身麻醉下猫的视网膜内层氧张力。
使用极谱氧微电极在吸入氧浓度为21%的情况下,测量氟烷麻醉下猫的视网膜内层氧张力。测量在视网膜内界膜100至200微米范围内的视网膜前玻璃体中进行。使用了三种氟烷麻醉水平:1.2%、2.4%和3.6%,分别对应0.5、1.0和1.5最低肺泡浓度。在整个实验过程中,猫的眼内压保持在恒定的正常水平。
在常氧条件下,随着氟烷麻醉深度增加,眼灌注压降低,视网膜内层氧张力保持不变或略有增加。
对于吸入21%氧气的猫,常用的氟烷全身麻醉手术水平不会导致视网膜内层缺氧。这可能是由于氟烷麻醉下视网膜血管自身调节得以保留、氟烷直接松弛平滑肌导致视网膜血管扩张,或氟烷麻醉下视网膜氧消耗减少所致。