Sieber F E, Brown P R, Wu Y, Koehler R C, Traystman R J
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21287-7834.
Anesthesiology. 1993 Nov;79(5):1013-21. doi: 10.1097/00000542-199311000-00020.
Previously, the authors found that anesthetized diabetic dogs had increased cerebral blood flow (CBF) and oxygen consumption (CMRO2). These results may have been influenced by anesthesia or surgery. The aim of this study was to determine whether CBF and CMRO2 are increased in the awake or anesthetized state in the absence of acute surgical stress in diabetic dogs. A second aim was to determine whether increased CBF and CMRO2 in diabetic dogs are mediated through beta-adrenergic mechanisms.
Diabetic dogs (n = 8) underwent total surgical pancreatectomy followed by 4 months of insulin management (16 +/- 0.4 units/day, mean +/- SE) to maintain fasting and 3 PM blood glucose 10-17 mM. Control dogs (n = 8) underwent sham operation followed by a 4-month convalescence. Using previously inserted catheters, CBF (radiolabelled microspheres) and CMRO2 (sagittal sinus sampling) were measured before and after propranolol (2 mg/kg) in both the awake and anesthetized states.
During the 4 months before CBF studies, the fasting blood glucose was greater in diabetic group than in the control group (11.0 +/- 0.3 vs. 4.0 +/- 0.1 mM, respectively). No difference occurred between groups in CBF or CMRO2. In the awake state, propranolol administration caused no CBF or CMRO2 changes. However, during anesthesia with 50 micrograms/kg fentanyl plus 10 mg/kg pentobarbital, propranolol administration decreased CBF in control, but not in diabetic, dogs.
The authors' previous results showing increased CBF and CMRO2 with diabetes may be secondary to a differential response to acute surgical stress, a factor that was eliminated in this study. These results indicate that diabetes is associated with changes in the beta-adrenergic system that become evident under fentanyl/pentobarbital anesthesia.
此前,作者发现麻醉状态下的糖尿病犬脑血流量(CBF)和氧耗量(CMRO2)增加。这些结果可能受到麻醉或手术的影响。本研究的目的是确定在无急性手术应激的情况下,糖尿病犬在清醒或麻醉状态下CBF和CMRO2是否增加。第二个目的是确定糖尿病犬中增加的CBF和CMRO2是否通过β-肾上腺素能机制介导。
糖尿病犬(n = 8)接受全胰切除术,随后进行4个月的胰岛素治疗(16±0.4单位/天,均值±标准误)以维持空腹及下午3点血糖在10 - 17 mM。对照犬(n = 8)接受假手术,随后恢复4个月。使用先前插入的导管,在清醒和麻醉状态下,于普萘洛尔(2 mg/kg)给药前后测量CBF(放射性微球法)和CMRO2(矢状窦采样法)。
在进行CBF研究前的4个月中,糖尿病组的空腹血糖高于对照组(分别为11.0±0.3与4.0±0.1 mM)。两组间CBF或CMRO2无差异。在清醒状态下,给予普萘洛尔未引起CBF或CMRO2变化。然而,在使用50微克/千克芬太尼加10毫克/千克戊巴比妥麻醉期间,给予普萘洛尔使对照犬的CBF降低,但糖尿病犬未降低。
作者先前显示糖尿病时CBF和CMRO2增加的结果可能继发于对急性手术应激的不同反应,本研究消除了该因素。这些结果表明,糖尿病与β-肾上腺素能系统的变化有关,在芬太尼/戊巴比妥麻醉下变得明显。