Effects of anesthetic and sedative agents on sympathetic nerve activity
Effects of anesthetic and sedative agents on sympathetic nerve activity
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DOI：
10.1016/j.hrthm.2019.06.017
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发表时间：
2019-12-01
期刊：
影响因子：
5.5
通讯作者：
Chen, Peng-Sheng
中科院分区：
文献类型：
--
作者：
Liu, Xiao;Rabin, Perry L.;Chen, Peng-Sheng
背景镇静和麻醉剂对交感神经活动(SNA)的影响尚不清楚。目的研究常用镇静和麻醉剂对犬和人体交感神经活动(SNA)的影响。方法在6只犬体内植入放射递质，记录星状神经节神经活动(SGNA)、皮下神经活动(SCNA)和血压(BP)。恢复后分别于不同时间注射右美托咪定3mU g/kg、吗啡0.1 mg/kg、氢化吗啡0.05 mg/kg、咪达唑仑0.1 mg/kg。我们还研究了12例人类患者(男性10例，年龄68.0+/-9.1岁)，在异丙酚(0.77+/-0.18 mg/kg)或甲氧己胺(0.65 mg/kg)麻醉下进行心房颤动复律。结果给予右美托咪啶(P=.000和P=.000)、吗啡(分别为P=.011和P=.014)和氢化吗啡(分别为P=.000和P=.012)后，SGNA和SCNA立即受到明显抑制，同时血压和心率(HR)下降(P<；均为.001)。咪达唑仑对活动犬的SGNA和SCNA无显著影响(P=.248和P=.149)，但增加HR(P=.015)和降低BP(P=.004)。在进行复律的患者中，丙泊酚团注显著抑制SKNA(从1.11+/-0.25 mU V到0.77+/-0.15 mU V；P=.001)，并且这种作用在最后一次复律休克后至少持续10分钟。甲氧己胺使胸腔SKNA由1.59±0.45 mU V降至1.22±0.58 mU V(P=.000)，ARM SKNA由0.76+/-0.43 mU V降至0.55+/-0.07 mU V(P=.001)。结论异丙酚、甲氧己胺、右美托咪定、吗啡和氢化吗啡酮对SNA均有抑制作用，但咪达唑仑对SNA无明显影响。
BACKGROUND The effects of sedative and anesthetic agents on sympathetic nerve activity (SNA) are poorly understood.OBJECTIVE The purpose of this study was to determine the effects of commonly used sedative and anesthetic agents on SNA in ambulatory dogs and humans.METHODS We implanted radiotransmitters in 6 dogs to record stellate ganglion nerve activity (SGNA), subcutaneous nerve activity (ScNA), and blood pressure (BP). After recovery, we injected dexmedetomidine (3 mu g/kg), morphine (0.1 mg/kg), hydromorphone (0.05 mg/kg), and midazolam (0.1 mg/kg) on different days. We also studied 12 human patients (10 male; age 68.0 +/- 9.1 years old) undergoing cardioversion for atrial fibrillation with propofol (0.77 +/- 0.18 mg/kg) or methohexital (0.65 mg/kg) anesthesia. Skin sympathetic nerve activity (SKNA) and electrocardiogram were recorded during the study.RESULTS SGNA and ScNA were significantly suppressed immediately after administration of dexmedetomidine (P = .000 and P = .000, respectively), morphine (P = .011 and P = .014, respectively), and hydromorphone (P = .000 and P = .012, respectively), along with decreased BP and heart rate (HR) (P < .001 for each). Midazolam had no significant effect on SGNA and ScNA (P = .248 and P = .149, respectively) but increased HR (P = .015) and decreased BP (P = .004) in ambulatory dogs. In patients undergoing cardioversion, bolus propofol administration significantly suppressed SKNA (from 1.11 +/- 0.25 mu V to 0.77 +/- 0.15 mu V; P = .001), and the effects lasted for at least 10 minutes after the final cardioversion shock. Methohexital decreased chest SKNA from 1.59 +/- 0.45 mu V to 1.22 +/- 0.58 mu V (P = .000) and arm SKNA from 0.76 +/- 0.43 mu V to 0.55 +/- 0.07 mu V (P = .001). The effects lasted for at least 10 minutes after the cardioversion shock.CONCLUSION Propofol, methohexital, dexmedetomidine, morphine, and hydromorphone suppressed, but midazolam had no significant effects on, SNA.