普罗波与德斯弗在莫亚莫亚病患者中的试点研究-一个试点研究
Ronak R Ankolekar1,2, Kirandeep Kaur1, Kiran Jangra1
1Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Asian journal of neurosurgery
|January 1, 2024
概括
在接受重血管化手术的莫亚莫亚病患者中,德斯弗兰和普罗波麻醉的神经结果相似. 普罗波提供了更好的外科外科条件,尽管德斯弗与增加对大脑放松措施的需求有关.
科学领域:
- 神经外科 神经外科
- 麻醉学 麻醉学
- 脑血管疾病 脑血管疾病
背景情况:
- 麻醉剂的选择在神经外科手术中至关重要,特别是在因潜在的脑缺血症而患有莫亚莫亚病 (MMD) 的患者中.
- 作为大脑血管扩张剂的desflurane可能在缺血性疾病中提供益处,与propofol的特性形成鲜明对比.
研究的目的:
- 为了比较desflurane与propofol麻醉在接受再血管化手术的MMD患者的神经结果.
- 评估影响手术条件和患者安全的手术内参数.
主要方法:
- 一个潜在的试点试验随机选择了MMD患者接受德斯弗兰或普罗波麻醉.
- 通过修改的兰金评分 (mRS) 和扩展的格拉斯哥结局评分 (GOS-E) 来评估神经学结果.
- 监测了手术内血液动力学,潮尾二氧化碳,和大脑放松分数 (BRS).
主要成果:
- 在德斯弗和普罗波组之间没有观察到mRS或GOS-E的显著差异.
- 脑放松评分 (BRS) 在德斯兰组显著更高,这表明外科外科条件较差.
- 在德斯兰组中,更高比例的患者需要为大脑放松采取救援措施 (70%).
结论:
- 手术后的神经结果在经过再血管化的MMD患者的德斯弗兰和普罗波麻醉之间是可比的.
- 与desflurane相比,propofol麻醉在这个患者群体中提供了优越的外科实地条件.
- 当在MMD手术中使用desflurane时,需要仔细考虑大脑放松和潜在的救援措施的需要.
相关概念视频
Parenteral Anesthetics: Overview
129
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
129
General Anesthesia: Overview
219
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
219
Inhalational Anesthetics: Overview
297
Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
297
Depolarizing Blockers: Pharmocokinetics
327
Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
327
Stages of General Anesthesia
449
Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
449
Local Anesthetics: Clinical Application as Spinal Anesthesia
635
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
635


