Artru A A, Powers K, Doepfner P
Department of Anesthesiology, University of Washington School of Medicine, Seattle 98195.
J Neurosurg Anesthesiol. 1994 Oct;6(4):239-48. doi: 10.1097/00008506-199410000-00003.
Previous studies to determine whether desflurane increases cerebrospinal fluid (CSF) pressure are inconclusive because none have included all of the following: multiple doses of desflurane, administration for at least several hours, examination at normo- and hypocapnia, a concurrent comparison group, direct measurement of both intra- and extracranial CSF pressures, and measurement of venous pressures that influence CSF pressure. The present study was designed to determine whether CSF pressure increases during 4.0 h desflurane anesthesia using a study design that included the above elements. Catheters were placed in the lateral cerebral ventricle, cisterna magna, sagittal sinus, and jugular vein of 12 dogs anesthetized with thiopental 12 mg.kg-1.h-1 and halothane 0.5 to 0.8%. Catheter pressures were measured, and the CSF-sagittal sinus pressure gradient and slope of the gradient to CSF pressure relationship were determined during control conditions. Then, 6 dogs were anesthetized with desflurane and 6 dogs were anesthetized with isoflurane, and the same values were determined for 1.0 h at each of four experimental conditions: 0.5 and 1.0 minimum alveolar concentration (MAC) during normocapnia (PaCO2 35-39 mm Hg) and 0.5 and 1.0 MAC during hypocapnia (PaCO2 20-24 mm Hg). CSF and sagittal sinus pressures, but not jugular venous pressure, increased with both desflurane and isoflurane. The greater increase of CSF pressure with 4.0 h desflurane (to 40.2 +/- 12.7 cm H2O) than with 4.0 h isoflurane (to 26.2 +/- 11.5 cm H2O) was attributable to an increase of CSF pressure that was greater during 2.0 h desflurane and normocapnia than during 2.0 h isoflurane and normocapnia, and to an increase of CSF pressure during 2.0 h desflurane and hypocapnia that was similar to that during 2.0 h isoflurane and hypocapnia. The greater increase of CSF pressure during desflurane may have resulted, in part, from increased CSF volume as indicated by a positive CSF-sagittal sinus pressure gradient (in contrast, there was little or no CSF-sagittal sinus pressure gradient during isoflurane) and a steeper slope of the gradient to CSF pressure relationship.
以往关于地氟醚是否会增加脑脊液（CSF）压力的研究尚无定论，因为这些研究均未涵盖以下所有方面：多剂量地氟醚、至少数小时的给药时间、在正常碳酸血症和低碳酸血症状态下进行检查、设立同期对照组、直接测量颅内和颅外脑脊液压力以及测量影响脑脊液压力的静脉压力。本研究旨在采用包含上述要素的研究设计，确定在4.0小时地氟醚麻醉期间脑脊液压力是否会升高。将导管置入12只以12mg·kg-1·h-1硫喷妥钠和0.5%至0.8%氟烷麻醉的犬的侧脑室、枕大池、矢状窦和颈静脉中。测量导管压力，并在对照条件下确定脑脊液-矢状窦压力梯度以及该梯度与脑脊液压力关系的斜率。然后，6只犬用地氟醚麻醉，6只犬用异氟醚麻醉，并在四种实验条件下的每一种条件下1.0小时内测定相同的值：正常碳酸血症（动脉血二氧化碳分压[PaCO2] 35 - 39mmHg）时的0.5和1.0最低肺泡浓度（MAC）以及低碳酸血症（PaCO2 20 - 24mmHg）时的0.5和1.0 MAC。地氟醚和异氟醚均使脑脊液和矢状窦压力升高，但颈静脉压力未升高。与4.0小时异氟醚（升至26.2±11.5cm H2O）相比，4.0小时地氟醚使脑脊液压力升得更高（升至40.2±12.7cm H2O），这归因于地氟醚和正常碳酸血症2.0小时期间脑脊液压力的升高幅度大于异氟醚和正常碳酸血症2.0小时期间，以及地氟醚和低碳酸血症2.0小时期间脑脊液压力的升高幅度与异氟醚和低碳酸血症2.0小时期间相似。地氟醚麻醉期间脑脊液压力升高幅度更大，部分原因可能是脑脊液-矢状窦压力梯度为正值表明脑脊液容量增加（相比之下，异氟醚麻醉期间脑脊液-矢状窦压力梯度很小或没有）以及该梯度与脑脊液压力关系斜率更陡。
