Short L H, Peterson R E, Mongan P D
Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX 78234-6200.
Anesth Analg. 1993 Feb;76(2):259-65. doi: 10.1213/00000539-199302000-00010.
Spinal-sciatic evoked responses (ScER) have been used successfully to monitor the integrity of the anterior spinal cord during spinal surgery. To evaluate the effects of hypercarbia, hypocarbia, induced hypotension, and hypothermia on the ScER, ten swine anesthetized with ketamine were subjected to varying levels of PaCO2, hypothermia, and induced hypotension. During variation of one physiologic variable, the other variables were closely regulated. There were no significant changes associated with variations in PaCO2. Decreasing temperature provided a consistent increase in latency (r = -0.78, P < 0.001) with no significant alteration in amplitude. Graded hypotension caused little increase in latency (3.2% at 30 mm Hg). The amplitude decrease averaged 23% at 60 mm Hg with a maximal decrease of 50% at 30 mm Hg. To study inhaled anesthetics, 21 swine anesthetized with ketamine were subjected to nitrous oxide (50% and 70%). After termination of the nitrous oxide, one of the potent inhaled anesthetics (n = 7 each) was administered in 0.25 minimum alveolar concentration (MAC) increments. Nitrous oxide caused a significant decrease in amplitude (average 43% and 61% at 50% and 70%) with minimal changes in latency. There was a dose-dependent decrease in amplitude and increase in latency with all inhaled anesthetics. The ScER disappeared at 1.0 MAC with all anesthetics. There were no differences between effects of equipotent concentrations of inhaled anesthetics. These findings may be helpful in the interpretation of the ScER response during anesthesia and surgery.
脊髓 - 坐骨神经诱发反应(ScER)已成功用于监测脊柱手术期间脊髓前部的完整性。为了评估高碳酸血症、低碳酸血症、诱导性低血压和低温对ScER的影响,对10只用氯胺酮麻醉的猪进行了不同水平的动脉血二氧化碳分压(PaCO2)、低温和诱导性低血压处理。在一个生理变量变化期间,密切调节其他变量。PaCO2变化未产生显著变化。温度降低使潜伏期持续增加(r = -0.78,P < 0.001),而波幅无显著改变。分级低血压使潜伏期略有增加(30毫米汞柱时增加3.2%)。60毫米汞柱时波幅平均降低23%,30毫米汞柱时最大降低50%。为研究吸入麻醉药,对21只用氯胺酮麻醉的猪给予氧化亚氮(50%和70%)。氧化亚氮停用后,以0.25最低肺泡浓度(MAC)的增量给予一种强效吸入麻醉药(每组7只)。氧化亚氮使波幅显著降低(50%和70%时平均分别降低43%和61%),潜伏期变化最小。所有吸入麻醉药均导致波幅呈剂量依赖性降低,潜伏期增加。所有麻醉药在1.0 MAC时ScER消失。等效浓度吸入麻醉药的作用之间无差异。这些发现可能有助于解释麻醉和手术期间的ScER反应。