【罂粟摘要】地氟醚和七氟醚对神经外科手术中躯体感觉诱发电位和运动诱发电位监测效果的影响:一项随机对照试验
地氟醚和七氟醚对神经外科手术中躯体感觉诱发电位和运动诱发电位监测效果的影响:一项随机对照试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：张中伟 编辑：张中伟 审校：曹莹
感觉诱发电位(SEP)和运动诱发电位(MEP)监测技术的使用为神经外科手术提供了更好的保护。然而，一些研究表明吸入卤化麻醉药对神经生理监测的效果有显著影响。
40名连续接受神经外科手术的患者被随机分为两组，分别接受地氟醚和七氟醚吸入麻醉。以最小肺泡浓度(MAC)为标准在多个水平(0.3、0.6和0.9)进行给药，然后记录SEPs和MEPs的潜伏期时长和波幅。
在接受神经外科手术的患者中，采用浓度为0.3、0.6和0.9 MAC的地氟醚或七氟醚作为全身麻醉中的吸入麻醉药，SEP和MEP信号保存良好。随着MAC的增加，SEPs和MEPs的波幅降低，SEPs潜伏期延长(P < 0.05)。地氟醚组上肢和下肢SEP的潜伏期均显著长于七氟醚组，SEP波幅显著低于七氟醚组(P < 0.05)。地氟醚组MEP波幅明显低于七氟醚组(P < 0.05)，仅上肢在0.3 MAC时波幅无明显变化。
地氟醚和七氟醚均对SEPs和MEPs有剂量依赖性抑制作用。在相同MAC下，地氟醚的抑制作用强于七氟醚。因本研究中所有患者的神经检查结果均正常，所以这项结论可能不适用于既往存在缺陷的患者。
Xiang Bingbing, Jiao Shulan, Zhang Yulong, et al. Effects of desflurane and sevoflurane on somatosensory-evoked and motor-evoked potential monitoring during neurosurgery: a randomized controlled trial.[J]. BMC Anesthesiol(2021) 21:240 : 1.
Effects of desflurane and sevoflurane on somatosensory-evoked and motor-evoked
potential monitoring during neurosurgery: a randomized controlled trial
Abstract
Background: Better protection can be provided during neurosurgery due to the establishment of somatosensory-evoked potential (SEP) and motor-evoked potential (MEP) monitoring technologies. However, some studies have showed that inhaled halogenated anesthetics have a significant impact on neurophysiological monitoring.
Method:A total of 40 consecutive patients undergoing neurosurgery were randomly assigned to two groups receiving inhaled anesthetics, either desflurane or sevoflurane. Multiples levels (concentrations of 0.3, 0.6 and 0.9) of anesthetics were administered at minimum alveolar concentration (MAC), and then the latencies and amplitudes of SEPs and MEPs were recorded.
Results:SEP and MEP signals were well preserved in patients who underwent neurosurgery under general anesthesia supplemented with desflurane or sevoflurane at concentrations of 0.3, 0.6 and 0.9 MAC. In each desflurane or
sevoflurane group, the amplitudes of SEPs and MEPs decreased and the latencies of SEPs were prolonged significantly as the MAC increased (P < 0.05). The SEP latencies of both the upper and lower limbs in the desflurane group were significantly longer, and the SEP amplitudes were significantly lower than those in the sevoflurane group (P < 0.05). The MEP amplitudes in the desflurane group were significantly lower than those in the sevoflurane group (P < 0.05), only the amplitudes of the upper limbs at 0.3 MAC did not vary significantly.
Conclusion:SEPs and MEPs were inhibited in a dose-dependent manner by both desflurane and sevoflurane. At the same MAC concentration, desflurane appeared to have a stronger inhibitory effect than sevoflurane. All patients
studied had normal neurological examination findings, hence, these results may not be applicable to patients with
preexisting deficits.
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