A QUESTFOR BETTER GENERALANESTHESIA TARGETING HEMODYNAMICSTABILITY FOR ORAL SURGEI

电刺激家兔颏神经后，收缩压（SBP）呈先降压后升压的双相反应。低频刺激后，三叉神经降压反应显著。TDR过程中大脑皮质局部血流量（rCBF）和组织氧分压的变化与电刺激迷走神经时相似，氧化亚氮可改善这种rCBF的降低，1.5最低肺泡浓度的异氟醚（含或不含氧化亚氮）可抑制这些降压和升压反应，但代价是正常血压。芬太尼抑制降压反应，可乐定、新斯的明和L-苯异丙基腺苷抑制升压反应。可乐定和L-苯基异丙基腺苷产生剂量依赖性SBP降低。喷他佐辛，与芬太尼相反，抑制升压反应。异丙酚和氯胺酮也抑制升压反应。这些结果表明，这些药物的适当组合，作用于不同部位的伤害性机制，可能会导致安全和有效的麻醉用于口腔手术。

Systolic blood pressure (SBP) showed biphagic (depressor followed by pressor) responses following electrical stimulation of the mental nerve in rabbits. Depressor response, known as the trigeminal depressor response, was prominent after low frequency stimulations. Changes in cerebral cortex regional blood flow (rCBF) and tissue oxygen tension during the TDR was similar to those during electrical vagal nerve stimulation.Nitrous oxide ameliorated this rCBF reduction.Isoflurane at 1.5 minimum alveolar concentration with or without nitrous oxide inhibited these depressor and pressor responses at the cost of normotension. Fentanyl inhibited depressor response, whereas clonidine, neostigmine and L-phenylisopropyladenosine inhibited pressor response. Clonidine and L-phenylisopropyladenosine produced dose-dependent SBP reduction. Pentazocine, in contrast to fentanyl, inhibited pressor response. Propofol and ketamine also inhibited pressor response. These results suggest that appropriate combinations of these drugs which act at different site of the nociceptive mechanisms may result in safe and effective anesthesia for oral surgery.