Kawaguchi M, Inoue S, Sakamoto T, Kawaraguchi Y, Furuya H, Sakaki T
Department of Anesthesiology, Nara Medical University, Japan.
Anesth Analg. 1999 Feb;88(2):446-51. doi: 10.1097/00000539-199902000-00041.
We investigated the effects of i.v. prostaglandin E1 (PGE1) on intraoperative changes of core temperature and the incidence of postoperative shivering in neurosurgical patients undergoing deliberate mild hypothermia. Eighty-three patients were randomly assigned to one of three groups: patients in the control group did not receive PGE1, whereas patients in the PG20 group and PG50 group received PGE1 at a dose of 0.02 and 0.05 microg x kg(-1) x min(-1), respectively. The administration of PGE1 was started just after the induction of anesthesia and continued until the end of anesthesia. Anesthesia was maintained with nitrous oxide in oxygen, sevoflurane, and fentanyl. After the induction of anesthesia, patients were cooled using a water blanket and a convective device blanket. Tympanic membrane temperature was maintained at 34.5 degrees C. During surgical wound closure, patients were rewarmed. Intraoperative changes in tympanic membrane and skin temperatures and the incidence of postoperative shivering were compared among groups. Demographic and intraoperative variables were similar among groups. There were no significant differences in tympanic temperatures among groups at each point during the operation. Skin temperature 30 min after rewarming and just after tracheal extubation was significantly lower in the PG20 group than in the PG50 group. Postoperative shivering was more frequent in the PG20 group (43%) than in the control (13%) and PG50 (17%) groups. These results suggest that the intraoperative administration of PGE1 does not affect changes in core temperature during deliberate mild hypothermia and that PGE1 at a dose of 0.02 microg x kg(-1) x min(-1) may increase the occurrence of postoperative shivering.
Deliberate mild hypothermia has been proposed as a means of providing cerebral protection during neurosurgical procedures. Vasodilating drugs may be used during deliberate mild hypothermia to maintain peripheral circulation and to enhance the cooling and rewarming rate. In the present study, however, we found no benefit from i.v. prostaglandin E1 administration during deliberate mild hypothermia in neurosurgical patients.
我们研究了静脉注射前列腺素E1（PGE1）对接受选择性轻度低温治疗的神经外科手术患者术中核心体温变化及术后寒战发生率的影响。83例患者被随机分为三组：对照组患者未接受PGE1，而PG20组和PG50组患者分别接受剂量为0.02和0.05微克·千克⁻¹·分钟⁻¹的PGE1。PGE1在麻醉诱导后即刻开始给药，并持续至麻醉结束。麻醉维持采用氧化亚氮、氧气、七氟醚和芬太尼。麻醉诱导后，患者使用水毯和对流装置毯进行降温。鼓膜温度维持在34.5℃。手术伤口缝合期间，患者进行复温。比较各组术中鼓膜温度和皮肤温度的变化以及术后寒战的发生率。各组间人口统计学和术中变量相似。术中各时间点各组间鼓膜温度无显著差异。复温30分钟后及气管拔管后即刻，PG20组的皮肤温度显著低于PG50组。PG20组术后寒战发生率（43%）高于对照组（13%）和PG50组（17%）。这些结果表明，术中给予PGE1不影响选择性轻度低温治疗期间核心体温的变化，且剂量为0.02微克·千克⁻¹·分钟⁻¹的PGE1可能会增加术后寒战的发生率。
选择性轻度低温已被提议作为神经外科手术期间提供脑保护的一种手段。在选择性轻度低温治疗期间可使用血管扩张药物维持外周循环并提高降温和复温速率。然而，在本研究中，我们发现在神经外科手术患者的选择性轻度低温治疗期间静脉注射PGE1并无益处。
