Effects of droperidol, pentobarbital, and ketamine on myogenic transcranial magnetic motor-evoked responses in humans.
Effects of droperidol, pentobarbital, and ketamine on myogenic transcranial magnetic motor-evoked responses in humans.
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氟哌利多、戊巴比妥和氯胺酮对人类肌源性经颅磁运动诱发反应的影响。
DOI：
10.1097/00008506-199507000-00016
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发表时间：
1995
期刊：
影响因子：
4.8
通讯作者：
R. Chesnut
中科院分区：
文献类型：
--
作者：
C. Kalkman;J. Drummond;P. Patel;T. Sano;R. Chesnut
肌源性运动诱发反应经颅磁刺激的运动皮层（tcmag-MER）可能成为临床上有用的无创评估运动通路传导手术期间。然而，由于大多数麻醉方案导致tcmag-MER振幅的严重抑制，因此应用受到阻碍。作为我们系统性尝试识别适合在tcmag-MER记录期间使用的麻醉剂和补充剂的一部分，我们研究了静脉注射戊巴比妥（1.5 mg/kg）、氟哌利多（0.07 mg/kg）或氯胺酮（1 mg/kg）的影响。对五名健康志愿者经颅磁刺激的复合肌肉动作电位。选择的剂量应与可能适用于补充一氧化二氮/阿片类麻醉技术的剂量相当。氟哌利多给药导致胫骨肌和拇收肌tc-MER的持续振幅降低至基线的30 +/- 9%和39 +/- 14%（P < 0.01）。戊巴比妥后Tcmag-MER振幅的变化是可变的，在两名受试者中，范围从无变化到大幅振幅降低（至基线的20%）。相比之下，氯胺酮给药未导致显著的振幅降低。在3名受试者中，氯胺酮给药后的前10分钟内，胫骨前肌振幅增加至对照值的150 - 220%。任何药物治疗后，发作潜伏期均无变化。这些数据表明，tcmag-MER在氟哌利多和戊巴比妥后中度抑制，但在氯胺酮后保持良好。氯胺酮可能比氟哌利多或戊巴比妥更适合作为阿片类药物/一氧化二氮麻醉的补充。
Myogenic motor-evoked responses to transcranial magnetic stimulation of the motor cortex (tcmag-MERs) may become clinically useful for the noninvasive assessment of motor pathway conduction during surgery. However, application is hindered because most anesthetic regimens result in severe depression of tcmag-MER amplitudes. As part of our systematic attempts to identify anesthetic agents and supplements suitable for use during tcmag-MER recording, we studied the effect of bolus doses of pentobarbital (1.5 mg/kg), droperidol (0.07 mg/kg), or ketamine (1 mg/kg), administered intravenously, on compound muscle action potentials to transcranial magnetic stimulation in five healthy volunteers. The doses were chosen to be comparable with doses that might be suitable for supplementation of a nitrous oxide/opioid anesthetic technique. Droperidol administration resulted in sustained amplitude depression of both tibialis and adductor pollicis tc-MERs to 30 +/- 9% and 39 +/- 14% of baseline (P < 0.01). Tcmag-MER amplitude changes after pentobarbital were variable, ranging from no change to substantial amplitude depression (to 20% of baseline) in two subjects. In contrast, ketamine administration did not result in significant amplitude depression. In three subjects, tibialis anterior amplitude increased to 150 to 220% of control values in the first 10 minutes after ketamine. Onset latency was unchanged after any drug. These data indicate that tcmag-MERs are moderately depressed after droperidol and pentobarbital but well preserved after ketamine. Ketamine may be a more suitable supplement to opioid/nitrous oxide anesthesia than droperidol or pentobarbital.