Ishizawa Y, Ohta S, Shimonaka H, Dohi S
Department of Anesthesiology and Critical Care Medicine, Gifu University School of Medicine, Gifu-city, Japan.
Anesthesiology. 1997 Aug;87(2):354-60. doi: 10.1097/00000542-199708000-00023.
Although hyper- and hypoglycemia induce neurophysiologic changes, there have been no reports on the effects of blood glucose changes on anesthetic requirements. This study examined the effects of hyper- and hypoglycemia on the minimum alveolar concentration (MAC) of halothane in rats. In addition, based on a previous finding that the level of brain acetylcholine was reduced during mild hypoglycemia, the authors examined the influence of physostigmine on MAC during hypoglycemia.
In Sprague-Dawley rats, anesthesia was induced and maintained with halothane in oxygen and air. The MAC was determined by observing the response to tail clamping and tested during mild hypoglycemia (blood glucose level, 60 mg/dl) and hyperglycemia (blood glucose level, 300 and 500 mg/dl) induced by insulin and glucose infusion, respectively (experiment 1). The effects of 0.3 and 1.0 mg/kg physostigmine given intraperitoneally on MAC were examined in rats with mild and severe hypoglycemia (blood glucose level, 60 and 30 mg/dl; experiment 2).
In experiment 1, mild hypoglycemia significantly reduced the MAC of halothane (0.76 +/- 0.03%) compared with the control value (0.92 +/- 0.04%), but hyperglycemia did not change MAC. In experiment 2, mild and severe hypoglycemia reduced MAC of halothane in a degree-dependent manner. Physostigmine (1 mg/kg) had no effect on MAC regardless of blood glucose level, but 0.3 mg/kg reduced MAC.
Hypoglycemia reduced anesthetic requirements in a degree-dependent manner, whereas hyperglycemia had no effects. Although the mechanism of hypoglycemic MAC reduction needs further investigations, physostigmine studies suggest that this may not be related to inhibition of cholinergic transmission.
尽管高血糖和低血糖会引起神经生理变化,但关于血糖变化对麻醉需求的影响尚无相关报道。本研究检测了高血糖和低血糖对大鼠氟烷最低肺泡浓度(MAC)的影响。此外,基于之前一项关于轻度低血糖时脑内乙酰胆碱水平降低的研究发现,作者检测了毒扁豆碱在低血糖期间对MAC的影响。
在斯普拉格 - 道利大鼠中,用氧气和空气中的氟烷诱导并维持麻醉。通过观察对夹尾的反应来确定MAC,并分别在胰岛素和葡萄糖输注诱导的轻度低血糖(血糖水平,60mg/dl)和高血糖(血糖水平,300和500mg/dl)期间进行测试(实验1)。在轻度和重度低血糖(血糖水平,60和30mg/dl)的大鼠中检测腹腔注射0.3和1.0mg/kg毒扁豆碱对MAC的影响(实验2)。
在实验1中,与对照值(0.92±0.04%)相比,轻度低血糖显著降低了氟烷的MAC(0.76±0.03%),但高血糖并未改变MAC。在实验2中,轻度和重度低血糖均以剂量依赖的方式降低了氟烷的MAC。无论血糖水平如何,毒扁豆碱(1mg/kg)对MAC均无影响,但0.3mg/kg可降低MAC。
低血糖以剂量依赖的方式降低麻醉需求,而高血糖则无此作用。尽管低血糖导致MAC降低的机制需要进一步研究,但毒扁豆碱的研究表明,这可能与胆碱能传递的抑制无关。