Sympathetic and hemodynamic effects of moderate and deep sedation with propofol in humans
Sympathetic and hemodynamic effects of moderate and deep sedation with propofol in humans
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DOI：
10.1097/00000542-200507000-00007
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发表时间：
2005-07-01
期刊：
影响因子：
8.8
通讯作者：
Ebert, TJ
中科院分区：
文献类型：
--
作者：
Ebert, TJ
背景资料：本研究的目的是确定参与的机制与镇静剂量的丙泊酚在humans.Methods：10名健康志愿者（年龄21-37岁）参加了两次，并在随机顺序接受安慰剂或丙泊酚输注低血压。将标准监测和桡动脉血压与前臂血流测量（体积描记法）和前臂血管阻力推导、腓神经交感神经活动记录和去甲肾上腺素浓度血样采集相结合。计算机控制的输注泵输送安慰剂或两种浓度的丙泊酚，根据观察者警觉性/镇静评分（反应性组分）4和3进行调整，以达到中度和深度镇静。镇静水平采用脑电图的双频谱分析进行定量。压力感受性反射进行了评估，通过管理的nitroprusside.Results：基线神经循环和呼吸参数之间没有显着差异。渐进式输注以达到中度和深度镇静，平均脑电双频指数值分别为70和54。异丙酚显著降低交感神经活动在两个水平的镇静和降低去甲肾上腺素和前臂血管阻力在深度镇静。这些作用导致中度和深度镇静时平均血压分别显著降低9%和18%。丙泊酚也减少反射增加交感神经activity.Conclusions：这些数据表明，从健康受试者的镇静剂量的丙泊酚，这并不损害呼吸功能，有实质性的抑制作用交感神经活动和反射反应，导致血管舒张和平均血压显着下降。
Background: The objective of this study was to determine the mechanisms involved in the hypotension associated with sedative doses of propofol in humans.Methods: Ten healthy volunteers (aged 21-37 yr) participated on two occasions and in random order received placebo or propofol infusions. Standard monitoring and radial artery blood pressure were combined with measurement of forearm blood flow (plethysmography) and derivation of forearm vascular resistance, recording of peroneal nerve sympathetic activity, and blood sampling for norepinephrine concentrations. A computer-controlled infusion pump delivered placebo or two concentrations of propofol, adjusted to achieve moderate and deep sedation based on the Observer Assessment of Alertness/Sedation score (responsiveness component) of 4 and 3. Level of sedation was quantitated using bispectral analysis of the electroencephalogram. Baroreflexes were assessed with a hypotensive challenge via administration of sodium nitroprusside.Results: Baseline neurocirculatory and respiratory parameters did not differ between sessions. Progressive infusions to achieve moderate and deep sedation resulted in average Bispectral index values of 70 and 54, respectively. Propofol significantly reduced sympathetic nerve activity at both levels of sedation and decreased norepinephrine and forearm vascular resistance at deep sedation. These effects resulted in significant decreases in mean blood pressure of 9% and 18% at moderate and deep sedation, respectively. Propofol also reduced reflex increases in sympathetic nerve activity.Conclusions: These data from healthy subjects indicate that sedation doses of propofol, which did not compromise respiratory function, had substantial inhibitory effects on sympathetic nerve activity and reflex responses to hypotension resulting in vasodilation and significant decreases in mean blood pressure.