Les nouveaux agents volatils halogénés en neuro-anesthésie : quelle place pour le sévoflurane ou le desflurane ?
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- 作者：De Deyne ; C. ; Joly ; L.-M. ; Ravussin ; P.
- 关键词：Anesthé ; sie par inhalation ; Sé ; voflurane ; Desflurane ; Neurochirurgie ; Hé ; modynamique cé ; ré ; brale ; Anesthetics ; Inhalation ; Sevoflurane ; Desflurane ; Neurosurgery ; Cerebral haemodynamics
- 刊名：Annales Francaises d'Anesthesie et de Reanimation
- 出版年：2004
- 出版时间：April, 2004
- 年：2004
- 卷：23
- 期：4
- 页码：367-374
- 全文大小：171 K
文摘
The effects on cerebral circulation and metabolism of sevoflurane and desflurane are largely comparable to isoflurane. Both induce a direct vasodilation of the cerebral vessels, resulting in a less pronounced decrease in cerebral blood flow compared to the decrease in cerebral metabolism. This direct vasodilation seems to be dose-dependent and more pronounced for desflurane > isoflurane > sevoflurane. Many reports suggest luxury perfusion at high concentrations of desflurane. Sevoflurane maintains intact cerebral autoregulation up to 1.5 MAC. Desflurane induces a significant impairment in autoregulation, with a completely abolished autoregulation at 1.5 MAC. Both sevoflurane and desflurane (up to 1.5 MAC) maintain normal CO2 regulation. As to their effect on final intracranial pressure (ICP), both sevoflurane and desflurane revealed no increases in ICP. However, compared to intravenous hypnotics, subdural ICP is higher with volatiles because of their tendency to increase cerebral swelling after dura opening (isoflurane > sevoflurane). Several case reports have noted seizure-like movements, as well as EEG recorded seizures during induction of sevoflurane anesthesia. Especially, in children during inhalational induction with hyperventilation at a high sevoflurane concentration, severe epileptiform EEG with a hyperdynamic response were observed, which urges for caution using inhalational sevoflurane induction in children for neurosurgical procedures. Neuroprotective properties (reduced neuronal death either by necrosis or apoptosis) have been attributed to all volatile agents. However, these neuroprotective effects have been described in experimental or animal models, so their possible effect on humans remains to be proven.