The Anesthetic Effects on Vasopressor Modulation of Cerebral Blood Flow in an Immature Swine Model
The Anesthetic Effects on Vasopressor Modulation of Cerebral Blood Flow in an Immature Swine Model
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DOI：
10.1213/ane.0b013e3182860fe7
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发表时间：
2013-04-01
影响因子：
5.7
通讯作者：
Friess, Stuart H.
中科院分区：
文献类型：
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作者：
Bruins, Benjamin;Kilbaugh, Todd J.;Friess, Stuart H.
背景：各种镇静剂和麻醉剂对儿童脑血流（CBF）的血管加压调节作用尚不清楚。在成人中，异氟烷降低CBF的程度低于芬太尼和咪达唑仑。大多数神经重症监护的大型动物模型使用吸入麻醉剂进行麻醉。涉及调制的调查。CBF将提高模型内的可翻译性，更接近儿科重症监护室的当前实践。方法：15只4周龄仔猪给予2种麻醉方案中的1种：全静脉麻醉（TIVA）（咪达唑仑1 mg/kg/h和芬太尼100 μ g/kg/h，n = 8）或ISO（异氟烷1.5%-2%和芬太尼100 μ g/kg/h，n = 7）。当小猪暴露于递增剂量的精氨酸加压素、去甲肾上腺素（NE）和苯肾上腺素（PE）时，连续测量平均动脉血压、颅内压（ICP）、CBF和脑组织氧分压。两组的基线CBF相似（ISO 38 +/- 10 vs TIVA 35 +/- 26 mL/100 g/min），尽管ISO组的基线脑灌注压较低（45 +/- 11 vs 71 +/- 11 mm Hg; P < 0.0005）。ISO组中的小猪随着PE和NE的出现而显示ICP升高（11 +/- 4 vs 16 +/- 4 mm Hg，11 +/- 8 vs 18 +/- 5 mm图; P < 0.05），但在TIVA组中，当将最大剂量值与基线数据进行比较时，仅PE暴露导致ICP升高（11 +/- 4 vs 15 +/- 5 mm Hg; P < 0.05）。当仔猪暴露于NE和PE时，麻醉组和血管加压药剂量的正常化CBF显示统计学显著性增加（P < 0.05），表明ISO内的自动调节受损，但不是TIVA.CONCLUSION：与挥发性麻醉剂相比，当使用基于麻醉剂-苯二氮卓类的麻醉剂方案时，对CBF的血管加压作用有限，与自动调节的保存一致。麻醉药物的选择是研究脑血管血流动力学机制的关键，并在实验室和床旁之间的翻译重症监护调查。（Anesth Analg 2013;116：838-44）
BACKGROUND: The effect of various sedatives and anesthetics on vasopressor modulation of cerebral blood flow (CBF) in children is unclear. In adults, isoflurane has been described to decrease CBF to a lesser extent than fentanyl and midazolam. Most large-animal models of neurocritical care use inhaled anesthetics for anesthesia. Investigations involving modulations. CBF would have improved translatability within a model that more closely approximates the current practice in the pediatric intensive care unit.METHODS: Fifteen 4-week-old piglets were given 1 of 2 anesthetic protocols: total IV anesthesia (TIVA) (midazolam 1 mg/kg/h and fentanyl 100 mu g/kg/h, n = 8) or ISO (isoflurane 1.5%-2% and fentanyl 100 mu g/kg/h, n = 7). Mean arterial blood pressure, intracranial pressure (ICP), CBF, and brain tissue oxygen tension were measured continuously as piglets were exposed to escalating doses of arginine vasopressin, norepinephrine (NE), and phenylephrine (PE).RESULTS: Baseline CBF was similar in the 2 groups (ISO 38 +/- 10 vs TIVA 35 +/- 26 mL/100 g/min) despite lower baseline cerebral perfusion pressure in the ISO group (45 +/- 11 vs 71 +/- 11 mm Hg; P < 0.0005). Piglets in the ISO group displayed increases in ICP with PE and NE (11 +/- 4 vs 16 +/- 4 mm Hg, and 11 +/- 8 vs 18 +/- 5 mm Fig; P < 0.05), but in the TIVA group, only exposure to PE resulted in increases in ICP when comparing maximal dose values with baseline data (11 +/- 4 vs 15 +/- 5 mm Hg; P < 0.05). Normalized CBF displayed statistically significant increases regarding anesthetic group and vasopressor dose when piglets were exposed to NE and PE (P < 0.05), suggesting an impairment of autoregulation within ISO, but not TIVA.CONCLUSION: The vasopressor effect on CBF was limited when using a narcotic-benzodiazepine based anesthetic protocol compared with volatile anesthetics, consistent with a preservation of autoregulation. Selection of anesthetic drugs is critical to investigate mechanisms of cerebrovascular hemodynamics, and in translating critical care investigations between the laboratory and bedside. (Anesth Analg 2013;116:838-44)