氟醚静脉麻醉脊髓血流量的变化

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1、SpinalCordBloodFlowChangebyIntravenousMidazolamDuringIsofluraneAnesthesiaTomokiNishiyama,MD,PhDByCorallibraBackgroundMidazolamhasbeenusedforgeneralanesthesiaandsedationduringlocalanesthesiaorartificialventilation.IthasbecomeclearthatmidazolamhasananalgesicpropertymediatedbyGABAreceptorsinthespin

2、alcord.Therefore,itisimportanttoknowtheeffectsofmidazolamonspinalcordbloodflow.MethodsanesthesiamaintainventilationMethodsMidlineskinincision,L1-5wereremoved,andthespinalcordwasexposed.Aplatinumwasinsertedstereotaxicallyintothespinalcordtoadepthof1mmat2mmlateraltothemidlineatL2.Spinalcordbloodfl

3、owwasmeasuredeiththehydrogenclearancemethod.Statisticalanalysiswasperformedwithrepeated-measuresanalysisofvarianceResultsArterialbloodgasvaluesbeforethestudydrugtreatmentwithoutanydifference.Arterialbloodpressuredecreasedduringthefirst30minafterMID2and4mg/KgHeartratedidnotchange.ResultsSpinalcor

4、dbloodflowincreasedsignificantlyfor90minafterMID1mg/Kgandfor15minafterMID2mg/Kg.DiscussionSpinalcordbloodflowwasincreasedbythesmallestdoseofIVmidazolamused(1mg/kg)withoutanychangesinarterialbloodpressureThelargestdose(4mg/kg)didnotinduceanychangesinspinalcordbloodflowbutdecreasedarterialbloodpre

5、ssureDiscussionSpinalcordbloodflowincreasedasETco2increased,butitdidnotchangewithmeanarterialbloodpressurebetween50and135mmHgorwithPao2morethan40mmHg(arterialbloodpressurewasintherangeofautoregulation)DiscussionSpinalcordbloodflowmightchangesimilarlytocerebralbloodflowBolusmidazolam(0.15mg/kg)de

6、creasedcerebralbloodflow,butmeanarterialbloodpressurealsodecreasedDiscussionIsofluraneincreasedspinalcordbloodflowwithinthearterialbloodpressurerangeof90–130mmHgThedecreaseinarterialbloodpressureinthemidazolam2and4mg/kggroupsmayhavedecreasedspinalcordbloodflowduringisofluraneanesthesiathatmasked

7、theincreaseotherwisecausedbymidazolamDiscussionHowever,inpatients,midazolamisoftencoadministeredwithotheranestheticsToknowtheeffectsofmidazolam,isofluraneshouldbediscontinuedConclusionAsmallerdoseofmidazolam(1mg/kg)increased