Farber N E, Poterack K A, Kampine J P, Schmeling W T
Department of Anesthesiology, Medical College of Wisconsin, Milwaukee 53226.
Anesthesiology. 1994 Apr;80(4):879-91; discussion 25A-26A. doi: 10.1097/00000542-199404000-00022.
Normal thermoregulatory function is believed to be modulated by thermosensitive neurons in the preoptic region of the anterior hypothalamus and other sites within the central nervous system including the spinal cord. Previous evidence has demonstrated modulation of segmental spinal cord thermoregulatory mechanisms from more rostral central nervous system sites. The ability of the volatile anesthetics to disrupt normal thermoregulatory function and produce shivering-like activity during emergence is well documented. The purpose of the current investigation was to examine the action purpose of the current investigation was to examine the action of the volatile anesthetics halothane, isoflurane, and enflurane on thermoregulatory responses produced at the preoptic region and spinal cord.
Cats were chronically instrumented with bilateral cannulas allowing selective heating and cooling of the preoptic region. Electrodes were implanted in hindlimb and forelimb muscles for electromyographic (EMG) analysis. Animals underwent selective heating and cooling of the preoptic region in the awake state, during volatile agent anesthesia and during emergence. In a separate series of animals, pontine-transected cats with epidural thermodes and a thermocouple underwent alternate heating and cooling of the spinal cord. Heating and alternate heating and cooling of the spinal cord. Heating and cooling was performed in the nonanesthetized state, at graded concentrations of halothane, and during emergence. In all animals deep core peritoneal temperature, epidural spinal cord temperature, forelimb and hindlimb EMG activity were continuously recorded and digitally processed. EMG responses in both experiments were quantitated and analyzed for power spectral density.
In the chronically prepared animals, heating and cooling of the preoptic region in the conscious state resulted in appropriate thermoregulatory responses, including shivering-like activity and increased EMG power with preoptic region cooling. Halothane, isoflurane, and enflurane each abolished these thermoregulatory responses. During emergence from anesthesia, however, the typical spontaneous increases in EMG power observed at normothermia were significantly attenuated by heating of the preoptic region and augmented by cooling of the preoptic region. In the acutely prepared animals, cooling of the spinal cord produced graded increases in EMG activity. Increased concentrations of halothane dose-dependently diminished this response to cooling of the spinal cord. During emergence, cooling of the spinal cord resulted in a shivering response similar to those observed during control conditions.
The ability of preoptic region heating and cooling to modulate postanesthetic shivering implies that while thermoregulatory pathways remain intact, volatile anesthetics produce an imprecision in the control of thermoregulatory responses at the level of the anterior hypothalamus. Attenuation of shivering-like responses generated at spinal cord levels in pontine-transected cats implies a significant blunting action of thermoregulatory response mechanisms at the level of the spinal cord or lower brain stem.
正常体温调节功能被认为是由下丘脑前部视前区以及包括脊髓在内的中枢神经系统其他部位的热敏神经元调节的。先前的证据表明,来自更靠前的中枢神经系统部位可调节脊髓节段性体温调节机制。挥发性麻醉药在苏醒过程中破坏正常体温调节功能并产生类似寒战活动的能力已有充分记录。本研究的目的是检查挥发性麻醉药氟烷、异氟烷和恩氟烷对视前区和脊髓产生的体温调节反应的作用。
给猫长期植入双侧套管,以便对视前区进行选择性加热和冷却。将电极植入后肢和前肢肌肉用于肌电图(EMG)分析。动物在清醒状态、挥发性麻醉剂麻醉期间和苏醒期间接受视前区的选择性加热和冷却。在另一组动物中,对有硬膜外温度传感器和热电偶的脑桥横断猫进行脊髓的交替加热和冷却。在非麻醉状态、不同浓度的氟烷以及苏醒期间进行脊髓的加热和交替加热及冷却。在所有动物中,连续记录并数字处理深部核心腹膜温度、硬膜外脊髓温度、前肢和后肢的肌电图活动。对两个实验中的肌电图反应进行定量并分析功率谱密度。
在长期准备的动物中,清醒状态下对视前区进行加热和冷却会产生适当的体温调节反应,包括类似寒战的活动以及视前区冷却时肌电图功率增加。氟烷、异氟烷和恩氟烷均消除了这些体温调节反应。然而,在麻醉苏醒期间,正常体温下观察到的典型肌电图功率自发增加在视前区加热时显著减弱,在视前区冷却时增强。在急性准备的动物中,脊髓冷却会使肌电图活动分级增加。氟烷浓度增加会剂量依赖性地减弱对脊髓冷却的这种反应。在苏醒期间,脊髓冷却会导致类似于对照条件下观察到的寒战反应。
视前区加热和冷却调节麻醉后寒战的能力意味着,虽然体温调节通路保持完整,但挥发性麻醉药在下丘脑前部水平对体温调节反应的控制产生了不精确性。脑桥横断猫脊髓水平产生的类似寒战反应的减弱意味着在脊髓或脑干下部水平体温调节反应机制有显著钝化作用。