EFFECTS OF PROPOFOL, ETOMIDATE, MIDAZOLAM, AND FENTANYL ON MOTOR EVOKED-RESPONSES TO TRANSCRANIAL ELECTRICAL OR MAGNETIC STIMULATION IN HUMANS
EFFECTS OF PROPOFOL, ETOMIDATE, MIDAZOLAM, AND FENTANYL ON MOTOR EVOKED-RESPONSES TO TRANSCRANIAL ELECTRICAL OR MAGNETIC STIMULATION IN HUMANS
复制标题
DOI：
10.1097/00000542-199204000-00003
复制
发表时间：
1992-04-01
期刊：
影响因子：
8.8
通讯作者：
BICKFORD, RG
中科院分区：
文献类型：
--
作者：
KALKMAN, CJ;DRUMMOND, JC;BICKFORD, RG
在5名健康志愿者中研究了丙泊酚、依托咪酯、咪达唑仑和芬太尼对经颅刺激运动诱发反应（tc-MER）的影响。 每名受试者在四个单独的疗程中接受丙泊酚2 mg.kg-1、依托咪酯0.3 mg.kg-1、咪达唑仑0.05 mg.kg-1和芬太尼3 μ g.kg-1的静脉推注剂量。 用500-700 V的阳极刺激引发电tc-MER（tc（e）-MER）。使用Cadwell MES-10磁刺激器以最大输出引发磁tc-MER（tc（mag）-MER）。 从胫骨前肌记录复合肌肉动作电位。 在药物注射前和注射后30 min内记录重复的tc（e）-MER和tc（mag）-MER。 在所有受试者中获得了可再现的基线tc（e）-MER（振幅4.7 +/- 0.43（SEM）mV，潜伏期29.4 +/- 0.35 ms）和tc（mag）-MER（振幅3.7 +/- 0.43 mV，潜伏期31.1 +/- 0.39 ms）。 丙泊酚注射后2 min，tc（e）-MER振幅明显下降，下降至基线值的2%（P < 0.01）。 注射异丙酚后30分钟，尽管明显缺乏镇静，但振幅仍下降至基线的44%（P < 0.05）。 咪达唑仑引起显著（P < 0.01）振幅降低，例如，tc（mag）-注射后5分钟MER降至基线值的16%。 在整个30分钟的研究期间，显著的抑郁持续存在。 芬太尼在这个小群体中没有引起任何统计学显著的振幅变化。 依托咪酯引起tc-MER振幅显著但短暂的降低。 然而，受试者之间存在相当大的差异。 任何药物治疗后潜伏期均无显著变化。 磁刺激和电刺激的药物诱导MER变化幅度相似，但在两种情况下，在药物诱导的抑制峰值时，当tc（e）-MER可记录时，tc（mag）-MER不存在。 由于依托咪酯后的振幅抑制不太明显，持续时间较短，因此当需要进行tc-MER监测时，依托咪酯作为诱导剂可能优于丙泊酚。 类似地，芬太尼作为静脉内补充剂可能优于咪达唑仑。
The effects of propofol, etomidate, midazolam, and fentanyl on motor evoked responses to transcranial stimulation (tc-MERs) were studied in five healthy human volunteers. Each subject, in four separate sessions, received intravenous bolus doses of propofol 2 mg.kg-1, etomidate 0.3 mg.kg-1, midazolam 0.05 mg.kg-1, and fentanyl 3-mu-g.kg-1. Electrical tc-MERs (tc(e)-MERs) were elicited with anodal stimuli of 500-700 V. Magnetic tc-MERs (tc(mag)-MERs) were elicited using a Cadwell MES-10 magnetic stimulator at maximum output. Compound muscle action potentials were recorded from the tibialis anterior muscle. Duplicate tc(e)-MERs and tc(mag)-MERs were recorded before and up to 30 min after drug injection. Reproducible baseline tc(e)-MERs (amplitude 4.7 +/- 0.43 (SEM) mV, latency 29.4 +/- 0.35 ms) and tc(mag)-MERs (amplitude 3.7 +/- 0.43 mV, latency 31.1 +/- 0.39 ms) were obtained in all subjects. Pronounced depression of tc(e)-MER amplitude to 2% of baseline values (P < 0.01) was observed 2 min after injection of propofol. Thirty minutes after injection of propofol, amplitude depression to 44% of baseline (P < 0.05) was still present, despite an apparent lack of sedation. Midazolam caused significant (P < 0.01) amplitude depression, e.g., tc(mag)-MER to 16% of baseline values 5 min after injection. Significant depression persisted throughout the 30-min study period. Fentanyl did not cause any statistically significant amplitude changes in this small population. Etomidate caused significant but transient depression of tc-MER amplitude. However, there was considerable intersubject variability. Latency did not change significantly after any drug. The magnitude of drug-induced MER changes was similar for magnetic and electrical stimulation, although in two instances, at the peak of drug-induced depression, tc(mag)-MERs were absent when tc(e)-MERs were recordable. Since amplitude depression after etomidate was less pronounced and of shorter duration, etomidate may be preferable to propofol as an induction agent when tc-MER monitoring is indicated. Similarly, fentanyl may be preferable to midazolam as an intravenous supplement.