Stuth E A, Dogas Z, Krolo M, Kampine J P, Hopp F A, Zuperku E J
Department of Anesthesiology, Medical College of Wisconsin and Zablocki Veterans Administration Medical Center, Milwaukee 53295, USA.
Anesthesiology. 1997 Dec;87(6):1440-9. doi: 10.1097/00000542-199712000-00023.
Previous studies in dogs showed that the phrenic nerve response to an acute hypoxic stimulus was dose dependently depressed by 0.5-2.0 minimum alveolar concentration (MAC) of halothane but not abolished. Because a carbon dioxide stimulus is transduced by a different mechanism in the carotid body chemoreceptors (CBCRs) than is a hypoxic stimulus, inhalational anesthetics may preferentially depress one of these transduction processes, the central neuronal processing, or both, of the integrated responses to these two types of inputs.
Carotid body chemoreceptor stimulation was produced by short (1-1.5 s), bilateral, 100% carbon dioxide in saline infusions into the carotid arteries during neural inspiration in unpremedicated, halothane-anesthetized, paralyzed, vagotomized dogs during constant mechanical ventilation. The phrenic neurogram quantified the neural inspiratory response. Four protocols were performed in the study: (1) the dose-dependent effects of halothane anesthesia (0.5-2.0 MAC) during hyperoxic hypercapnia on phrenic nerve activity, (2) the effects of three background levels of the partial pressure of carbon dioxide (PaCO2) on the magnitude of the carbon dioxide infusion responses at 1 MAC halothane, (3) the effects of anesthetic type on the magnitude of the carbon dioxide infusion response, and (4) the effects of CBCR denervation.
Peak phrenic nerve activity (PPA) increased significantly during the carbon dioxide-stimulated phrenic burst in protocols 1-3; after denervation there was no response (protocol 4). Halothane produced a dose-dependent reduction in the PPA of control and carbon dioxide infusion-stimulated phrenic bursts and in the net carbon dioxide response. The net PPA responses for the different PaCO2 background levels were not different but were somewhat larger for sodium thiopental anesthesia than for 1.0 MAC halothane.
The phrenic nerve response to an acute, severe carbon dioxide stimulus was dose dependently depressed by surgical doses of halothane. The observed responses to carbon dioxide infusion were mediated by the CBCRs because they were eliminated by CBCR denervation. These results suggest that the CBCR transduction and central transmission of the carbon dioxide signal in terms of inspiratory excitatory drive are not abolished at surgical levels of halothane anesthesia.
先前对犬类的研究表明,在氟烷浓度为0.5 - 2.0最低肺泡浓度(MAC)时,膈神经对急性低氧刺激的反应呈剂量依赖性降低,但并未消除。由于二氧化碳刺激在颈动脉体化学感受器(CBCRs)中的转导机制与低氧刺激不同,吸入性麻醉药可能会优先抑制这两种转导过程之一、中枢神经元处理过程,或同时抑制这两种对这两种类型输入的综合反应。
在未用术前药、氟烷麻醉、麻痹、迷走神经切断的犬类进行持续机械通气期间,在神经吸气时,通过短时间(1 - 1.5秒)双侧向颈动脉内注入100%二氧化碳生理盐水来刺激颈动脉体化学感受器。膈神经电图量化神经吸气反应。该研究进行了四个方案:(1)在高氧高碳酸血症期间,氟烷麻醉(0.5 - 2.0 MAC)对膈神经活动的剂量依赖性影响;(2)三种二氧化碳分压(PaCO2)背景水平对1 MAC氟烷时二氧化碳注入反应幅度的影响;(3)麻醉类型对二氧化碳注入反应幅度的影响;(4)CBCR去神经支配的影响。
在方案1 - 3中,二氧化碳刺激膈神经爆发时,膈神经活动峰值(PPA)显著增加;去神经支配后无反应(方案4)。氟烷使对照和二氧化碳注入刺激的膈神经爆发的PPA以及净二氧化碳反应呈剂量依赖性降低。不同PaCO2背景水平的净PPA反应无差异,但硫喷妥钠麻醉时的反应比1.0 MAC氟烷时略大。
手术剂量的氟烷可使膈神经对急性、严重二氧化碳刺激的反应呈剂量依赖性降低。观察到的对二氧化碳注入的反应由CBCRs介导,因为CBCR去神经支配消除了这些反应。这些结果表明,在氟烷麻醉的手术水平下,CBCR对二氧化碳信号的转导和中枢传递在吸气兴奋驱动方面并未被消除。