Exacerbation or unmasking of focal neurologic deficits by sedatives
Exacerbation or unmasking of focal neurologic deficits by sedatives
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DOI：
10.1097/00000542-199607000-00004
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发表时间：
1996-07-01
期刊：
影响因子：
8.8
通讯作者：
Crosby, G
中科院分区：
文献类型：
--
作者：
Thal, GD;Szabo, MD;Crosby, G
背景资料：在脑肿瘤或颈动脉手术后出现的患者中观察到短暂的局灶性神经功能缺损，并且麻醉剂的药理作用被认为是这种神经功能障碍的原因，因此，在颈动脉疾病或脑肿块病变患者中前瞻性地和术前研究了咪达唑仑或芬太尼镇静对运动神经功能的影响。54名患有颈动脉疾病或脑肿瘤的未预先用药的成年患者在术前期间静脉内给予小剂量的2.8 +/- 1.3 mg咪达唑仑或170 +/- 60 μ g芬太尼，在基线和镇静后由不了解患者疾病或症状细节的个体进行彻底的运动检查，精神状态检查也进行了控制的不注意或缺乏合作的影响，在神经系统examination.Results：患者镇静轻度，但完全合作。30%的患者在镇静后发生局灶性运动恶化，芬太尼组和咪达唑仑组的发生率相似。在基线检查时有局灶性运动异常或先前运动缺陷已解决的患者中，73%的患者因镇静而加重或暴露这些体征，而没有运动功能障碍既往史的患者均未出现镇静诱导的变化。镇静诱导的神经功能变化范围从单侧轻度无力到完全瘫痪，但似乎本质上是短暂的。咪达唑仑或芬太尼镇静可短暂加重或暴露既往运动功能障碍患者的局灶性运动障碍。
Background: Transient focal neurologic deficits have been observed in patients emerging from brain tumor or carotid surgery, and a pharmacologic effect of anesthetic agents has been proposed as the cause of such neurologic dysfunction, Therefore, the effect of sedation with midazolam or fentanyl on motor neurologic function was studied prospectively and preoperatively in patients with carotid disease or mass lesions of the brain.Methods: Fifty-four unpremedicated adult patients with carotid disease or a brain tumor were given small intravenous doses of either 2.8 +/- 1.3 mg midazolam or 170 +/- 60 mu g fentanyl in the preoperative period, A thorough motor examination was performed at baseline and after sedation by an individual who was unaware of the details of the patient's disease or symptoms, A mental status examination also was performed to control for the effects of inattentiveness or lack of cooperation during the neurologic examination.Results: Patients were sedated mildly but were fully cooperative. Focal motor deterioration occurred after sedation in 30% of patients, and the incidence was similar in patients in the fentanyl and midazolam groups. Among patients with a focal motor abnormality on baseline examination or a resolved prior motor deficit, 73% had exacerbation or unmasking of these signs by sedation, whereas no patient without a prior history of motor dysfunction had a sedative-induced change, Sedative-induced changes in neurologic function ranged from unilateral mild weakness to complete plegia, but appeared to be transient in nature.Conclusions: Sedation with midazolam or fentanyl can transiently exacerbate or unmask focal motor deficits in patients with prior motor dysfunction.