Segawa H, Mori K, Murakawa M, Kasai K, Shirakami G, Adachi T, Arai T
Department of Anesthesia, Kyoto University Hospital, Japan.
Anesthesiology. 1998 Dec;89(6):1407-13. doi: 10.1097/00000542-199812000-00018.
Suppression of hypertensive response to noxious stimulation by volatile anesthetics may be a result of suppression of the stimulation-induced norepinephrine response or that of the cardiovascular response to catecholamines, or both. The suppression of the cardiovascular response is established, but that of norepinephrine response has not been confirmed. The authors hypothesized that the suppression of cardiovascular response but not that of norepinephrine response plays a major role in suppressing the noxious stimulation-induced hypertensive response by volatile anesthetics.
Forty healthy donors for living-related liver transplantation were allocated to four groups: receiving 1.2% (end-tidal) isoflurane in oxygen and nitrogen, 2.0% isoflurane, 1.7% sevoflurane, or 2.8% sevoflurane. The intraoperative plasma norepinephrine and epinephrine concentrations, arterial blood pressure and pulse rate were measured for the first 15 min of surgery and were compared with the preoperative values.
Norepinephrine and epinephrine concentrations both increased intraoperatively in all four groups. The values of maximum increase and area under the concentration-versus-time curve of norepinephrine were greater in the high dose groups of both anesthetics. The intraoperative blood pressure did not differ by different doses of anesthetics, and the degree of increase of blood pressure was not proportional to the plasma catecholamine concentrations.
The effects of isoflurane and sevoflurane on the surgical noxious stimulation-induced norepinephrine response were inversely proportional to the dose. The suppression of noxious stimulation-induced blood pressure response by anesthetics that were studied may be the result of suppression of the responses of vascular smooth muscle and myocardium to catecholamines.
挥发性麻醉药对有害刺激引起的高血压反应的抑制作用，可能是由于抑制了刺激诱导的去甲肾上腺素反应，或抑制了心血管对儿茶酚胺的反应，或两者皆有。心血管反应的抑制作用已得到证实，但去甲肾上腺素反应的抑制作用尚未得到证实。作者推测，挥发性麻醉药抑制有害刺激引起的高血压反应的主要作用是抑制心血管反应，而非去甲肾上腺素反应。
40名活体肝移植健康供体被分为四组：分别接受氧气和氮气中1.2%（呼气末）异氟烷、2.0%异氟烷、1.7%七氟烷或2.8%七氟烷。在手术的前15分钟测量术中血浆去甲肾上腺素和肾上腺素浓度、动脉血压和脉搏率，并与术前值进行比较。
所有四组术中去甲肾上腺素和肾上腺素浓度均升高。两种麻醉药的高剂量组中，去甲肾上腺素的最大增加值和浓度-时间曲线下面积值更大。术中血压在不同剂量麻醉药之间无差异，血压升高程度与血浆儿茶酚胺浓度不成正比。
异氟烷和七氟烷对手术有害刺激诱导的去甲肾上腺素反应的影响与剂量成反比。所研究的麻醉药对有害刺激诱导的血压反应的抑制作用，可能是血管平滑肌和心肌对儿茶酚胺反应受到抑制的结果。
