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本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见 Patients Undergoing Orthotopic Liver Transplantation Require Lower Concentrations of theVolatile Anesthetic Sevoflurane 背景与目的 七氟烷是一种挥发性麻醉药，常用于行原位肝移植（OLT）术的终末期肝病（ESLD）患者的麻醉维持。越来越多的证据表明，与肝功能尚存的病人相比，终末期肝病患者对麻醉药物的需求量降低。挥发性麻醉药的效力以最小肺泡浓度（MAC）表示。在这项前瞻性盲研究中，我们对行腹部大手术肝功能正常患者和行OLD的ESLD患者的MAC值进行了比较。 方 法 异丙酚麻醉诱导，通过评价行腹部大手术肝功能正常患者和OLT时的初始皮肤切口运动反应测定七氟烷MAC值。使用狄克逊“上下”法获得MAC，并比较各组之间的差异。此外，我们还记录了皮肤切开前后的脑电双频指数。 结 果 本研究包括20例接受OLT和20例对照处理的患者，接受OLT患者的MAC为1.3%（95%可信区间[CI]，1.1-1.4），正常肝功能患者MAC为1.7%（95% CI, 1.6-1.9），相当于ESLD患者的MAC值相对减少了26%（95% CI, 14-39）。在切皮前3分钟（47 [95% CI, 40-53] vs 35 [95% CI, 31-40], P = .011），切皮前1分钟（48 [95% CI, 42-54] vs 37 [95% CI, 33-43], P = .03），切皮后1分钟（57 [95% CI, 50-64] vs 41 [95% CI, 36-47], P < .001）， ESLD患者脑电双频指数比对照组高。 结 论 我们的研究结果表明，在异丙诱导麻醉中，与正常肝功能患者相比，终末期肝病患者七氟烷MAC是降低的。然而，我们没有测量皮肤切开时的丙泊酚浓度，MAC的差异应谨慎解释，因为在皮肤切开时可能存在残留的异丙酚。 原始文献摘要 Baron-Stefaniak J1, Götz V, Allhutter A, Schiefer J Patients Undergoing Orthotopic Liver Transplantation Require Lower Concentrations of theVolatile Anesthetic Sevoflurane Anesth Analg. Sep 2017;125(3):783-789. doi: 10.1213/ANE.0000000000002250 BACKGROUND: Sevoflurane is a volatile anesthetic commonly used to maintain anesthesia in patients with end-stage liver disease (ESLD) undergoing orthotopic liver transplantation (OLT). Growing evidence suggests that patients with ESLD have decreased anesthetic requirements compared to patients with preserved liver function. The potency of volatile anesthetics is expressed as the minimum alveolar concentration (MAC). In this prospective, blinded study, we compared the MAC of sevoflurane among patients with ESLD undergoing OLT and patients with normal liver function undergoing major abdominal surgery. METHODS: After propofol-induced anesthesia, the MAC of sevoflurane was assessed by evaluating motor response to initial skin incision in patients undergoing OLT and in patients with normal liver function undergoing major abdominal surgery. The MAC was determined using Dixon "up-and-down" method and compared between groups. In addition, the bispectral index was documented immediately before and after skin incision. RESULTS: Twenty patients undergoing OLT and 20 control patients were included in the study. The MAC of sevoflurane in patients undergoing OLT was 1.3% (95% confidence interval [CI], 1.1-1.4). In comparison, the MAC of sevoflurane in patients with normal liver function was 1.7% (95% CI, 1.6-1.9), equal to a relative reduction of the MAC in patients with ESLD of 26% (95% CI, 14-39). The bispectral index was higher in patients with ESLD than in control patients at 3 minutes before (47 [95% CI, 40-53] vs 35 [95% CI, 31-40], P = .011), 1 minute before (48 [95% CI, 42-54] vs 37 [95% CI, 33-43], P = .03), and 1 minute after skin incision (57 [95% CI, 50-64] vs 41 [95% CI, 36-47], P < .001). CONCLUSIONS: Our results suggest that the MAC of sevoflurane is lower in patients with ESLD than in patients with normal liver function after propofol-induced anesthesia. However, as we did not measure propofol concentrations at the time of skin incision, the difference in MAC should be interpreted with caution given that residual propofol may have been present at the time of skin incision. 麻醉学文献进展分享 联系我们 |
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