Hosoda R, Hattori M, Shimada Y
Department of Anesthesiology, Branch Hospital, Nagoya University School of Medicine, Japan.
Acta Anaesthesiol Scand. 1993 Jul;37(5):469-74. doi: 10.1111/j.1399-6576.1993.tb03748.x.
Fourteen adult patients undergoing elective major abdominal surgery were divided into two groups. One group received epidural and general anesthesia (epidural group), and 20 ml of 0.125% bupivacaine and 2 mg of morphine were administered epidurally about 30 min before the end of the operation for post-anesthetic analgesia. The other group (control group) received general anesthesia alone with nitrous oxide, oxygen and enflurane. Flow-directed pulmonary arterial and radial arterial catheters were inserted preoperatively, and hemodynamic, respiratory, neuroendocrine and metabolic variables were measured serially. The data were compared during anesthesia and the immediate post-anesthetic recovery period. In the control group, the plasma epinephrine level in the post-anesthetic recovery period increased about four times over the anesthetic period. Oxygen consumption was increased and mixed venous oxygen saturation was decreased significantly. There was a close linear correlation between oxygen consumption (Y) and plasma epinephrine (X) level: Y = 285.7X + 90.5 (P < 0.01, r = 0.72). On the other hand, plasma epinephrine, oxygen consumption and mixed venous oxygen saturation did not change significantly in the epidural group in the post-anesthetic recovery period. There was also a close linear correlation between oxygen consumption (Y) and oxygen delivery (X): Y = 0.22X-32.0 (P < 0.01, r = 0.89). We conclude that the surgical stress and anesthetic reversal may seriously influence neuroendocrine responses and subsequently increase plasma epinephrine. Tissue oxygenation and metabolic imbalance may occur due to the rapid increase of epinephrine in the post-anesthetic recovery period. Epidural analgesia at this period may play a more important role and have a more favorable effect on the tissue metabolism.
14名接受择期腹部大手术的成年患者被分为两组。一组接受硬膜外麻醉和全身麻醉（硬膜外组），在手术结束前约30分钟硬膜外注射20毫升0.125%布比卡因和2毫克吗啡用于术后镇痛。另一组（对照组）仅接受氧化亚氮、氧气和安氟醚的全身麻醉。术前插入肺动脉漂浮导管和桡动脉导管，并连续测量血流动力学、呼吸、神经内分泌和代谢变量。在麻醉期间和麻醉后即刻恢复期对数据进行比较。对照组中，麻醉后恢复期血浆肾上腺素水平比麻醉期间增加了约四倍。氧耗增加，混合静脉血氧饱和度显著降低。氧耗（Y）与血浆肾上腺素（X）水平之间存在密切的线性相关性：Y = 285.7X + 90.5（P < 0.01，r = 0.72）。另一方面，硬膜外组在麻醉后恢复期血浆肾上腺素、氧耗和混合静脉血氧饱和度没有显著变化。氧耗（Y）与氧输送（X）之间也存在密切的线性相关性：Y = 0.22X - 32.0（P < 0.01，r = 0.89）。我们得出结论，手术应激和麻醉苏醒可能严重影响神经内分泌反应，随后增加血浆肾上腺素。由于麻醉后恢复期肾上腺素的快速增加，可能会发生组织氧合和代谢失衡。在此期间硬膜外镇痛可能发挥更重要的作用，并对组织代谢产生更有利的影响。
