Effects of remifentanil-based general anaesthesia with propofol or sevoflurane on muscle microcirculation as assessed by near-infrared spectroscopy
Effects of remifentanil-based general anaesthesia with propofol or sevoflurane on muscle microcirculation as assessed by near-infrared spectroscopy
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DOI：
10.1093/bja/aen136
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发表时间：
2008-08-01
影响因子：
9.8
通讯作者：
Pinto, G.
中科院分区：
文献类型：
--
作者：
De Blasi, R. A.;Palmisani, S.;Pinto, G.
背景虽然麻醉剂是已知的改变微循环没有研究，据我们所知，记录在全身麻醉过程中人体骨骼微循环功能的变化。44例在大学医院接受颌面部手术的患者前瞻性随机接受瑞芬太尼联合丙泊酚或七氟烷的全身麻醉。在全身麻醉诱导前和诱导30分钟后，采用近红外光谱（NIRS）研究肌肉微循环。使用NIRS装置（NIMO，Nirox）定量小牛脱氧血红蛋白[HHb]、氧合血红蛋白[HbO（2）]和总血红蛋白[HbT]浓度，结合一系列静脉和动脉闭塞测量小牛血流量、肌肉耗氧量、小牛血管阻力、微血管顺应性和血红蛋白再饱和率（RR）。在这两组中，全身麻醉引起肌肉微循环的显著变化：组织血容量增加（瑞芬太尼-七氟烷组为+33%，瑞芬太尼-丙泊酚组为+45%），微血管阻力降低（分别为-31%和-38%），缺血后血红蛋白RR降低（分别为-48%和-36%）。瑞芬太尼-丙泊酚组肌血流量增加（P < 0.001），瑞芬太尼-七氟醚组微血管顺应性和肌耗氧量降低（P < 0.01）。瑞芬太尼为基础的全身麻醉与丙泊酚或七氟醚改变肌肉微循环在不同的方式。定量NIRS是一种考虑个体受试者的光学组织特性的技术，可以有效地非侵入性地测量这些变化。
Background. Although anaesthetics are known to alter microcirculation no study has, to our knowledge, documented changes in human skeletal microcirculatory function during general anaesthesia.Methods. Forty-four patients undergoing maxillofacial surgery at a university hospital were prospectively randomized to receive general anaesthesia with remifentanil combined with propofol or sevoflurane. Muscle microcirculation was investigated with near-infrared spectroscopy (NIRS) before general anaesthesia was induced and 30 min later. An NIRS device (NIMO, Nirox) was used to quantify calf deoxyhaemoglobin [HHb], oxyhaemoglobin [HbO(2)], and total haemoglobin [HbT] concentrations, coupled to a series of venous and arterial occlusions to measure calf blood flow, muscle oxygen consumption, calf vascular resistance, microvascular compliance, and haemoglobin resaturation rate (RR).Results. In both the groups, general anaesthesia induced marked changes in muscle microcirculation: the tissue blood volume increased (+33% in remifentanil-sevoflurane and +45% with remifentanil-propofol groups), microvascular resistance decreased (-31% and -38%, respectively), and the post-ischaemic haemoglobin RR decreased (-48% and -36%, respectively). In the remifentanil-propofol group, the muscle blood flow increased (P < 0.001), whereas in the remifentanil-sevoflurane group microvascular compliance and muscle oxygen consumption decreased (P < 0.01).Conclusions. Remifentanil-based general anaesthesia with propofol or sevoflurane altered the muscle microcirculation in different ways. Quantitative NIRS, a technique that takes into account the optical tissue properties of the individual subject, can effectively measure these changes non-invasively.