Zbinden A M, Petersen-Felix S, Thomson D A
Institute for Anesthesiology and Intensive Care, University Hospital, Bern, Switzerland.
Anesthesiology. 1994 Feb;80(2):261-7. doi: 10.1097/00000542-199402000-00005.
The hemodynamic effects of isoflurane have been studied extensively. However, most data are obtained from volunteers or patients in the absence of surgical stimulation. The hemodynamic responses to various stimulation patterns of different intensity have not been evaluated.
In 26 patients, the ability of isoflurane to suppress motor and hemodynamic reactions in response to noxious stimulations of variable degree (trapezius squeeze, tetanic stimulation, laryngoscopy, skin incision, and laryngoscopy plus intubation) was evaluated by measuring arterial blood pressure and heart rate before and after stimulation.
At concentrations that inhibited motor response to these stimuli in 50% of all patients, systolic blood pressure increased by 9 (trapezius squeeze), 15 (tetanic stimulation), 23 (laryngoscopy), 35 (skin incision) and 49 (intubation) mmHg, and heart rate by 5 (trapezius squeeze), 15 (tetanic stimulation), 17 (laryngoscopy), 36 (skin incision), and 36 (intubation) min-1 compared to the prestimulation values. An analysis using multiple regression showed that blood pressure response was influenced most by the type of stimulation followed by the concomitantly occurring motor reaction, the anesthesia time, and least by the isoflurane concentration per se. A high isoflurane concentration had no influence on the magnitude of blood pressure or heart rate increase to stimulation, but it decreased the prestimulation blood pressure and slightly increased the prestimulation heart rate. Heart rate responses were less consistent than those of blood pressure.
Isoflurane used as a sole agent is unable to suppress hemodynamic reactions (blood pressure and heart rate) to painful stimuli. A "normal" blood pressure following stimulation can be achieved only if prestimulation blood pressure is depressed to levels that may be clinically unacceptable. The lack of motor response is not an accurate predictor of the ability of an agent to depress hemodynamic reaction.
异氟烷的血流动力学效应已得到广泛研究。然而，大多数数据是在没有手术刺激的情况下从志愿者或患者身上获得的。尚未评估对不同强度的各种刺激模式的血流动力学反应。
在26例患者中，通过测量刺激前后的动脉血压和心率，评估异氟烷抑制对不同程度有害刺激（斜方肌挤压、强直刺激、喉镜检查、皮肤切开以及喉镜检查加插管）的运动和血流动力学反应的能力。
在所有患者中有50%对这些刺激的运动反应受到抑制的浓度下，与刺激前值相比，收缩压在斜方肌挤压时升高9 mmHg、强直刺激时升高15 mmHg、喉镜检查时升高23 mmHg、皮肤切开时升高35 mmHg以及插管时升高49 mmHg，心率在斜方肌挤压时升高5次/分钟、强直刺激时升高15次/分钟、喉镜检查时升高17次/分钟、皮肤切开时升高36次/分钟以及插管时升高36次/分钟。多元回归分析表明，血压反应受刺激类型影响最大，其次是同时出现的运动反应、麻醉时间，而异氟烷浓度本身影响最小。高异氟烷浓度对刺激引起的血压或心率升高幅度没有影响，但会降低刺激前血压并轻微升高刺激前心率。心率反应不如血压反应一致。
单独使用异氟烷无法抑制对疼痛刺激的血流动力学反应（血压和心率）。只有将刺激前血压降低到临床可能无法接受的水平，才能在刺激后达到“正常”血压。运动反应的缺乏并不是一种药物抑制血流动力学反应能力的准确预测指标。
