Tanaka S, Tsuchida H, Nakabayashi K, Seki S, Namiki A
Department of Anesthesiology, Sapporo Medical University School of Medicine, Japan.
Anesth Analg. 1996 Apr;82(4):821-6. doi: 10.1097/00000539-199604000-00025.
A rapid increase in isoflurane or desflurane concentration induces tachycardia and hypertension and increases-plasma catecholamine concentration. Little information is available as to whether sevoflurane, halothane, and enflurane induce similar responses during anesthesia induction via mask. Fifty ASA physical status I patients, aged 20-40 yr, and scheduled for elective minor surgery, received one of four volatile anesthetics: sevoflurane, isoflurane, halothane, or enflurane. Anesthesia was induced with thiamylal, followed by inhalation of 0.9 minimum alveolar anesthetic concentration (MAC) of the anesthetic in 100% oxygen via mask. The inspired concentration of anesthetic was increased by 0.9 MAC every 5 min to a maximum of 2.7 MAC. Heart rate (HR) and systolic blood pressure (SBP) were measured before and every minute for 15 min during anesthetic inhalation. In the sevoflurane and isoflurane groups, venous blood samples were drawn to determine the concentrations of plasma epinephrine and norepinephrine 3 min after each increase in anesthetic concentration. Sustained increments in HR were observed after increases in inspired isoflurane concentration to 1.8 MAC and 2.7 MAC (peak changes of 15 +/- 3 and 17 +/- 3 bpm, respectively). Isoflurane also increased SBP transiently after the inspired concentration was increased to 2.7 MAC (peak change of 10 +/- 4 mm Hg). Enflurane increased HR after the inspired concentration was increased to 2.7 MAC (peak change of 9 +/- 2 bpm). In contrast, changes in sevoflurane and halothane concentrations did not induce hyperdynamic responses. Plasma norepinephrine concentration in the isoflurane group was significantly higher than that in the sevoflurane group during 2.7 MAC (P = 0.022). We propose that there is a direct relationship between airway irritation of the anesthetic and immediate cardiovascular change during an inhaled induction of anesthesia.
异氟烷或地氟烷浓度的快速增加会诱发心动过速和高血压，并增加血浆儿茶酚胺浓度。关于七氟烷、氟烷和恩氟烷在面罩麻醉诱导期间是否会引发类似反应，目前所知甚少。五十名年龄在20至40岁之间、ASA身体状况为I级且计划进行择期小手术的患者，接受了四种挥发性麻醉剂之一：七氟烷、异氟烷、氟烷或恩氟烷。先用硫喷妥钠诱导麻醉，然后通过面罩在100%氧气中吸入0.9倍最低肺泡有效浓度（MAC）的麻醉剂。每隔5分钟将吸入的麻醉剂浓度增加0.9 MAC，最高增至2.7 MAC。在吸入麻醉期间，于麻醉前及之后的15分钟内每分钟测量心率（HR）和收缩压（SBP）。在异氟烷组，当吸入的异氟烷浓度增加至1.8 MAC和2.7 MAC后，观察到HR持续升高（峰值变化分别为15±3和17±3次/分钟）。当吸入浓度增加至2.7 MAC后，异氟烷还会使SBP短暂升高（峰值变化为10±4毫米汞柱）。当吸入浓度增加至2.7 MAC后，恩氟烷会使HR升高（峰值变化为9±2次/分钟）。相比之下，七氟烷和氟烷浓度的变化并未引发高动力反应。在2.7 MAC期间，异氟烷组的血浆去甲肾上腺素浓度显著高于七氟烷组（P = 0.022）。我们认为，在吸入麻醉诱导期间，麻醉剂对气道的刺激与即刻心血管变化之间存在直接关系。
