应用SPECT研究地氟醚麻醉对人脑血流分布的影响

目的研究吸入不同浓度地氟醚麻醉下健康志愿者脑血流(CBF)分布的动态变化。方法选择9名志愿者,每位志愿者分别在清醒、吸入0.5和1.0MAC地氟醚后采用单光子发射计算机断层成像(SPECT)仪进行扫描,观察地氟醚麻醉下人局部脑血流(rCBF)的动态变化。结果全脑CBF计数在清醒时为127.5±23.1,吸入0.5MAC地氟醚麻醉后全脑CBF计数为130.8±25.4,吸入1.0MAC地氟醚后为128.8±22.9,三组间比较差异无显著意义;额叶、顶叶、颞叶、枕叶、中脑、小脑、丘脑、海马、基底核、扣带回和舌回等脑区rCBF计数差异也均无显著意义。结论在保持PETCO2和MAP稳定且在正常范围时,吸入地氟醚麻醉不影响人脑内血流量的分布。     

地氟醚低流量洗入紧闭环路麻醉的摄取规律

目的 研究地氟醚高浓度、低流量洗入时的摄取规律。方法 择期全麻下行上腹部手术的ASA I-Ⅱ级患者80例,随机分为A、B两组,洗入期:A组新鲜气流量为:氧气0.7 L/min;B组新鲜气流量为:氧气0.4 L/min,氧化亚氮 0.3 L/min。两组Tec-6地氟醚蒸发器刻度均为18％。维持期:两组新鲜气流量均不变,蒸发器刻度均改为8％。结果 A组平均洗入时间为（4.56±0.68）min,B组平均洗入时间为（4.05±0.52）min,二者无统计学差异（P>0.05）。两组间各时点 FA/FI均无显著差异（P>0.05）。结论 低流量洗入地氟醚、氧化亚氮时,氧化亚氮并不影响地氟醚的体内摄取过程。地氟醚低流量洗入紧闭环路麻醉安全可行。     

代氟醚和安氟醚低流量循环密闭吸入全麻的临床观察

使用低流量循环密闭回路内注入给药法，比较１ＭＡＣ代氟醚和安氟醚各１４例维持全麻时循环动力苏醒情况和不良反应。结果；代氟醚在维持阶段对心血管系统的抑制较安氟醚为轻，很可能和代氟醚能使交感神经兴奋性增加有关。     

异氟醚、地氟醚对维库溴铵残余肌松作用的影响

目的　观测异氟醚、地氟醚对维库溴铵的残余肌松作用的影响。方法　选择 4 9例ASAⅠ～Ⅱ级成年择期全麻手术病人 ,随机分为三组 :丙泊酚组 (Ⅰ组 ,18例 ) ;异氟醚组 (Ⅱ组 ,17例 ) ;地氟醚组 (Ⅲ组 ,14例 )。全麻诱导气管插管后维库溴铵均以 90 μg·kg-1·h-1的速度静脉泵入。Ⅰ组丙泊酚泵入速度为 4～ 10mg·kg-1·h-1;Ⅱ组、Ⅲ组分别吸入呼气末浓度为 1MAC的异氟醚或地氟醚 ,使用Biometer加速度仪观测T1恢复至 2 5 %、75 %及TOF比值 (T4/T1)恢复至 0 7的时间。结果　三组间病人的性别、年龄、体重、身高、芬太尼总量、麻醉持续时间、血液动力学变化均无显著性差异 (P >0 0 5 )。上述恢复时间 ,Ⅱ组、Ⅲ组与Ⅰ组比较均延长 ,有显著差异 (P <0 0 5 ) ;Ⅱ、Ⅲ组比较差别无统计学意义 (P >0 0 5 )。三组间恢复指数 (T1从 2 5 %～ 75 %时间 )比较无显著差异 (P >0 0 5 )。结论　异氟醚、地氟醚均可延长维库溴铵的残余肌松作用 ,但两者比较无明显差别。临床应用中应注意监测四个成串刺激 (TOF)等 ,减少术后残余肌松作用所致的并发症     

老年患者全身麻醉和脊柱麻醉后的诱导、维持和复苏特性分析

目的：比较使用3种全身麻醉方法和脊髓麻醉对老年患者的诱导和复苏特性。方法研究对象为100例接受尿道手术的60岁以上患者，根据麻醉方式不同分为丙泊酚-丙泊酚（ P-P ），丙泊酚-异氟烷（P-I），丙泊酚-地氟烷（P-D）组，每组25例，分别由芬太尼（1～2μg/kg IV）和丙泊酚（1．0～2．0 mg/kg IV）诱导麻醉，并分别用含70％N2 O的氧气同时注射丙泊酚（75～150μg· kg-1· min-1）或异氟烷（呼气0．7％～1．2％）或地氟烷（呼气1％～4％），维持麻醉状态。诱导麻醉后接上通气喉罩，维持自主呼吸。在脊髓麻醉组（S），患者鞘内注射1．5 mL溶于等体积10％葡萄糖注射液中的4％利多卡因（60 mg）麻醉。结果与脊髓麻醉相比（9．3±3．4）min，丙泊酚诱导麻醉的技术方法比较简单并且诱导速度更快（P＜0．01）（P-P，P-I和P-D组麻醉的诱导时间分别为（4．6±1．7）min，（4．7±2．2）min和（3．8±1．4）min。在诱导期内，S组病例的主动脉压和心率更高。3个全身麻醉组患者，在麻醉诱导，拔管和定位时间相近。 S组病例产生疼痛得分更低（P＜0.05），但复苏观察时间更长（P＜0．01）。 P-P和P-D组患者数字符号替换测验（DSST）得分恢复到基础水平的时间比P-I组稍短。麻醉方法不同对于患者术后恶心，嗜睡，焦虑和协调性没有影响。结论老年患者使用丙泊酚和地氟烷诱导全身麻醉可以缩短诱导和复苏时间，且不会产生副作用。因此这种方法适用于老年患者在经尿道手术中使用。     

The Effects of Desflurane on Human Platelet Aggregation In Vitro

In view of the possible antiplatelet effects of general anesthetics, we investigated the in vitro effects of desflurane, a new inhalation agent, on platelet aggregation. For 15 patients who underwent elective operations, blood was sampled with desflurane induction before and after anesthesia but prior to surgery so that platelet aggregation in the drawn blood could be tested before desflurane anesthesia and again after exposure to the anesthetic. Platelet aggregation was measured with a whole-blood aggregometer. Adenosine diphosphate (ADP), collagen, and ristocetin were used as aggregating agents. Our results showed that aggregation in response to ADP, collagen, or ristocetin was not inhibited in patients who received desflurane anesthesia. This study with an in vitro model showed that desflurane had no influence on platelets in clinically relevant doses.     

Kidney Function in Living Donors Undergoing Nephrectomy by Sevoflurane or Desflurane Anesthesia

Purpose

Although there is no clinical evidence of nephrotoxicity with the volatile anesthetics currently used in general anesthesia, a better agent should be needed in terms of preserving postoperative renal function in living kidney donors who have only single remaining kidney. The purpose of the current retrospective, single-center study was to evaluate and compare renal function of living kidney donors after nephrectomy under either sevoflurane or desflurane anesthesia.

Materials and Methods

From January 2006 through December 2011, a total of 228 donors undergoing video assisted minilaparotomy surgery nephrectomy for kidney donation were retrospectively enrolled in the current study. The donors were categorized into a sevoflurane group or desflurane group based on the type of volatile anesthetic used. We collected laboratory data from the patients preoperatively, immediately after the operation, on the first postoperative day and on the third postoperative day. We also compared renal function of the kidney donors after donor nephrectomy by comparing creatinine level and estimated glomerular filtration rate (eGFR).

Results

The decrease in renal function after surgery in both groups was the most prominent on the first postoperative day. There were no significant differences between the two groups in postoperative changes of creatinine or eGFR.

Conclusion

Sevoflurane and desflurane can be used safely as volatile anesthetics in donors undergoing nephrectomy.     

Metalloproteinase expression after desflurane preconditioning in hepatectomies: A randomized clinical trial

BACKGROUNDHepatectomy with inflow occlusion results in ischemia-reperfusion injury; however, pharmacological preconditioning can prevent such injury and optimize the postoperative recovery of hepatectomized patients. The normal inflammatory response after a hepatectomy involves increased expression of metalloproteinases, which may signal pathologic hepatic tissue reformation. AIMTo investigate the effect of desflurane preconditioning on these inflammatory indices in patients with inflow occlusion undergoing hepatectomy.METHODSThis is a single-center, prospective, randomized controlled trial conducted at the 4^th Department of Surgery of the Medical School of Aristotle University of Thessaloniki, between August 2016 and December 2017. Forty-six patients were randomized to either the desflurane treatment group for pharmacological preconditioning (by replacement of propofol with desflurane, administered 30 min before induction of ischemia) or the control group for standard intravenous propofol. The primary endpoint of expression levels of matrix metalloproteinases and their inhibitors was determined preoperatively and at 30 min posthepatic reperfusion. The secondary endpoints of neutrophil infiltration, coagulation profile, activity of antithrombin III (AT III), protein C (PC), protein S and biochemical markers of liver function were determined for 5 d postoperatively and compared between the groups.RESULTSThe desflurane treatment group showed significantly increased levels of tissue inhibitor of metalloproteinases 1 and 2, significantly decreased levels of matrix metalloproteinases 2 and 9, decreased neutrophil infiltration, and less profound changes in the coagulation profile.  During the 5-d postoperative period, all patients showed significantly decreased activity of AT III, PC and protein S (vs baseline values, P < 0.05). The activity of AT III and PC differed significantly between the two groups from postoperative day 1 to postoperative day 5 (P < 0.05), showing a moderate drop in activity of AT III and PC in the desflurane treatment group and a dramatic drop in the control group. Compared to the control group, the desflurane treatment group also had significantly lower international normalized ratio values on all postoperative days (P < 0.005) and lower serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase values on postoperative days 2 and 3 (P < 0.05).   Total length of stay was significantly less in the desflurane group (P = 0.009).CONCLUSIONDesflurane preconditioning can lessen the inflammatory response related to ischemia-reperfusion injury and may shorten length of hospitalization.     

The differential effects of equipotent doses of isoflurane and desflurane on hippocampal acetylcholine levels in young and aged rats

The differential effects of age-adjusted equipotent doses of isoflurane (Iso) and desflurane (Des) on hippocampal acetylcholine (ACh) levels were examined using cerebral microdialysis in young (12–16 weeks old) and aged (16–18 months old) Fischer 344 rats. An 80 min exposure to 1 minimum alveolar concentration (MAC) of isoflurane and desflurane produced similar maximal decreases in hippocampal ACh levels in both age groups: to 36.3 ± 13.9% (Iso) and 28.6 ± 12.9% (Des) of baseline in aged rats versus 32.5 ± 18.7% (Iso) and 29.6 ± 12.5% (Des) of baseline in young rats. Compared to isoflurane, the onset of this maximal decrease was delayed in both age groups with desflurane. Furthermore, following the end of anesthesia in aged rats, hippocampal ACh levels returned to control levels faster with desflurane (within 20–40 min) than isoflurane (within 60–80 min). These data demonstrate that age-adjusted equipotent doses of isoflurane and desflurane produce similar maximal decreases in hippocampal ACh levels in a manner that is independent of age. However, compared to isoflurane, desflurane is associated with a slower decrease in and a faster restoration of hippocampal ACh levels following anesthesia in this rat model of aging. Hence, in the aged, the administration of age-adjusted equipotent doses of an inhalational anesthetic with low blood and tissue solubility, such as desflurane, may provide a viable pharmacotherapeutic strategy for minimizing the duration of the attenuation of hippocampal cholinergic outflow observed following anesthesia.     

比较地氟醚与异丙酚对单肺通气时肺内分流的影响

目的 以异丙酚作对照观测地氟醚对单侧肺通气时低氧性肺血管收缩的影响.方法 择期行左侧开胸的成年手术患者20例,ASAⅠ～Ⅱ级,随机分为丙泊酚组(P组)、0.5MAC地氟醚组(D组),每组10例.分别用咪唑安定0.2mg/kg(D组)、丙泊酚3μg/ml靶控输注(P组),及芬太尼4 μg/kg和罗库溴铵0.9 mg/kg行静脉诱导,经口插入Mallinckrodt右双腔支气管导管.以3%地氟醚(D组)、丙泊酚(P组,以血浆靶浓度为3 μg/ml速度输注)、芬太尼、罗库溴铵维持麻醉.于双肺通气15 min(TLV-15)、右单肺通气15 min(OLV-15)、右单肺通气30 min(OLV-30)时取足背动脉血和右心房静脉血做血气分析,计算Qs/Qt.结果 单肺通气后,D组和P组Qs/Qt增加明显(P＜0.05),但OLV-1时D组Qs/Qt增幅比P组小36%(P＜0.05);而在OLV-30时D组Qs/Qt增幅比P组小39%(P＜0.05).两组单肺通气后PaO2降幅均超过40%(P＜0.01).结论 与异丙酚比较,0.5MAC地氟醚对单肺通气时低氧性肺血管收缩影响轻微.