在接受经蝶窦垂体切除术的正常碳酸血症患者中，地氟烷和异氟烷会增加腰段脑脊液压力。

Desflurane and isoflurane increase lumbar cerebrospinal fluid pressure in normocapnic patients undergoing transsphenoidal hypophysectomy.

作者信息

Talke P, Caldwell J, Dodsont B, Richardson C A

机构信息

Department of Anesthesia, UCSF 94143-0648, USA.

出版信息

Anesthesiology. 1996 Nov;85(5):999-1004. doi: 10.1097/00000542-199611000-00006.

DOI:10.1097/00000542-199611000-00006

PMID:8916815

Abstract

BACKGROUND

Rapid emergence from anesthesia makes desflurane an attractive choice as an anesthetic for patients having neurosurgery. However, the data on the effect of desflurane on intracranial pressure in humans are still limited and inconclusive. The authors hypothesized that isoflurane and desflurane increase intracranial pressure compared with propofol.

METHODS

Anesthesia was induced with intravenous fentanyl and propofol in 30 patients having transsphenoidal hypophysectomy with no evidence of mass effect, and it was maintained with 70% nitrous oxide in oxygen and a continuous 100 micrograms.kg-2.min-1 infusion of propofol. Patients were assigned to three groups randomized to receive only continued propofol infusion (n = 10), desflurane (n = 10), or isoflurane (n = 10) for 20 min. During the 20-min study period, each patient in the desflurane and isoflurane groups received, in random order, two concentrations (0.5 minimum alveolar concentration [MAC] and 1.0 MAC end-tidal) of desflurane or isoflurane for 10 min each. Lumbar cerebrospinal fluid (CSF) pressure, blood pressure, heart rate, and anesthetic concentrations were monitored continuously.

RESULTS

Lumbar CSF pressure increased significantly in all patients receiving desflurane or isoflurane. Lumbar CSF pressure increased by 5 +/- 3 mmHg at 1-MAC concentrations of desflurane and by 4 +/- 2 mmHg at 1-MAC concentrations of isoflurane. Cerebral perfusion pressure decreased by 12 +/- 10 mmHg at 1-MAC concentrations of desflurane and by 15 +/- 10 mmHg at 1-MAC concentrations of isoflurane. Heart rate increased by 7 +/- 9 bpm with 0.5 MAC desflurane and by 8 +/- 7 bpm with 1.0 MAC desflurane, and by 5 +/- 11 bpm with 1.0 MAC isoflurane. Systolic blood pressure decreased in all but the patients receiving 1.0 MAC desflurane. To maintain blood pressure within predetermined limits, phenylephrine was administered to six of ten patients in the isoflurane group (range, 25 to 600 micrograms), two of ten patients in the desflurane group (range, 200 to 500 micrograms), and in no patients in the propofol group. Lumbar CSF pressure, heart rate, and systolic blood pressure did not change in the propofol group.

CONCLUSION

Desflurane and isoflurane, at 0.5 and 1.0 MAC, increase lumbar CSF pressure.

摘要

背景

麻醉后快速苏醒使地氟烷成为神经外科手术患者麻醉的一个有吸引力的选择。然而，关于地氟烷对人体颅内压影响的数据仍然有限且尚无定论。作者推测，与丙泊酚相比，异氟烷和地氟烷会增加颅内压。

方法

30例行经蝶窦垂体切除术且无占位效应证据的患者，静脉注射芬太尼和丙泊酚诱导麻醉，并用70%氧化亚氮和氧气以及持续输注100微克·千克⁻²·分钟⁻¹的丙泊酚维持麻醉。患者被随机分为三组，分别为仅持续输注丙泊酚组（n = 10）、地氟烷组（n = 10）或异氟烷组（n = 10），每组持续20分钟。在20分钟的研究期间，地氟烷组和异氟烷组的每位患者随机接受两种浓度（0.5最低肺泡有效浓度[MAC]和1.0 MAC呼气末浓度）的地氟烷或异氟烷，每种浓度持续10分钟。持续监测腰段脑脊液（CSF）压力、血压、心率和麻醉浓度。

结果

所有接受地氟烷或异氟烷的患者腰段CSF压力均显著升高。地氟烷1-MAC浓度时腰段CSF压力升高5±3 mmHg，异氟烷1-MAC浓度时升高4±2 mmHg。地氟烷1-MAC浓度时脑灌注压降低12±10 mmHg，异氟烷1-MAC浓度时降低15±10 mmHg。0.5 MAC地氟烷时心率增加7±9次/分钟，1.0 MAC地氟烷时增加8±7次/分钟，1.0 MAC异氟烷时增加5±11次/分钟。除接受1.0 MAC地氟烷的患者外，所有患者的收缩压均降低。为将血压维持在预定范围内，异氟烷组10名患者中有6名（剂量范围为25至600微克）、地氟烷组10名患者中有2名（剂量范围为200至500微克）使用了去氧肾上腺素，丙泊酚组无患者使用。丙泊酚组腰段CSF压力、心率和收缩压未发生变化。