Schwender D, Weninger E, Schnatmann N, Mulzer S, Klasing S, Peter K
Institut für Anästhesiologie, Ludwig-Maximilians-Universität München.
Anaesthesist. 1995 Jul;44(7):478-82. doi: 10.1007/s001010050179.
We have studied mid-latency auditory evoked potentials (MLAEP) during general anaesthesia with sufentanil in ten patients scheduled for elective major urological surgery. Anaesthesia was induced with sufentanil 2-3 micrograms/kg; for maintenance of anaesthesia a further bolus of sufentanil (1-2 micrograms/kg) 10 min before the start of surgery (skin incision) was given. MLAEP were recorded before and 10 min after the last sufentanil bolus on the vertex (positive) and mastoids on both sides (negative). Latencies of the peaks V, Na, Pa, Nb, and Pl (ms) and amplitudes Na/Pa, Pa/Nb, and Nb/Pl (microV) were measured.
In the awake state, MLAEP had high peak-to-peak amplitudes and a periodic wave form. During general anaesthesia with sufentanil the brainstem response V was stable. There was a marked increase in latency and a decrease in the amplitude of Nb and Pl. In contrast, for the early cortical potentials Na and Pa only small increases in latencies and decreases in amplitudes were observed. Na and Pa showed a similar pattern to that in awake patients.
There is no substantial difference of sufentanil's effect on MLAEP compared with the opioids alfentanil, fentanyl, and morphine. Because Na, Pa, and Nb are generated in the primary auditory cortex of the temporal lobe, it must be concluded that during general anaesthesia with sufentanil primary cortical processing of auditory stimuli may be preserved.
我们对10例计划接受择期大型泌尿外科手术的患者在使用舒芬太尼全身麻醉期间的中潜伏期听觉诱发电位(MLAEP)进行了研究。用2 - 3微克/千克的舒芬太尼诱导麻醉;为维持麻醉,在手术开始(皮肤切开)前10分钟再给予一次舒芬太尼推注(1 - 2微克/千克)。在最后一次舒芬太尼推注前和推注后10分钟,在头顶(阳性)和双侧乳突(阴性)记录MLAEP。测量V、Na、Pa、Nb和Pl峰的潜伏期(毫秒)以及Na/Pa、Pa/Nb和Nb/Pl的波幅(微伏)。
在清醒状态下,MLAEP具有较高的峰峰值波幅和周期性波形。在使用舒芬太尼全身麻醉期间,脑干反应V是稳定的。Nb和Pl的潜伏期显著增加,波幅降低。相比之下,对于早期皮质电位Na和Pa,仅观察到潜伏期有小幅度增加,波幅有小幅度降低。Na和Pa显示出与清醒患者相似的模式。
与阿芬太尼、芬太尼和吗啡等阿片类药物相比,舒芬太尼对MLAEP的影响没有实质性差异。由于Na、Pa和Nb是在颞叶的初级听觉皮层产生的,因此可以得出结论,在使用舒芬太尼全身麻醉期间,听觉刺激的初级皮质处理可能得以保留。