Okuläre Kreislaufveränderungen bei Halothan-Lachgas-Intubationsnarkose unter besonderer Berücksichtigung des arteriellen CO2-Partialdrucks - Teil 1: Phänomenologie der Veränderungen

Abstract

In 20 patients (5 with cataract, 15 with strabismus), general anesthesia was performed using halothane (inspiratory concentration: 0.5 vol.%) and nitrous oxide (65 vol.%); thiopental was employed for induction of anesthesia, vecuronium and succinylcholine were used for neuromuscular blockade prior to intubation. In series 1, the patients were slightly hyperventilated (PCO2 33 mmHg, on average). In series 2, the arterial PCO2 was changed in a range between 20 and 45 mmHg. By means of oculo-oscillo-dynamography, we determined the systolic retinal and ciliary perfusion pressures (PPs,ret and PPs,cil) as well as the respective ocular blood pressures (Ps,ret and Ps,cil), the ocular pulsation volume (PVoc) and the pulsatile ocular blood flow (Fp,oc = PVoc x heart rate). The intraocular pressure (Pio) was measured with the Draeger hand-applanation tonometer. Results of series 1: Measured 5 and 15 min after intubation, PPs,ret was reduced by averages of 12.5 and 20.2 mmHg, respectively, corresponding to decreases of 13.1 and 21.2% compared to the initial values. Ps,ret was decreased by 15.4 mmHg (14.2%) 5 min after intubation and by 27.1 mmHg (25.0%) 15 min after intubation. The ciliary pressures (PPs,cil and Ps,cil) were changed by similar amounts. PVoc was reduced by 0.3 microliters (50.8%) during both time periods after intubation. Fp,oc was lowered by 19.5 microliters/min (41.0%) and by 26.4 microliters/min (55.5%), measured 5 and 15 min after intubation, respectively. Pio was decreased by 1.6 mmHg (11.3%) and by 7.6 mmHg (53.5%), respectively. The systolic brachial artery pressure was reduced by 12.6 mmHg (9.5%) 5 min after intubation and by 29.1 mmHg (21.9%) 15 min after intubation. The diastolic branchial artery pressure showed a slight initial increase, followed by a small decrease. All changes were highly significant (P less than 0.001; 1-factor analysis of variance plus Scheffé test). Results of series 2: In a PCO2 range between 40 and 45 mmHg (normo-until slight hypoventilation; determined 5 min after intubation), PVoc and Fp,oc averaged 0.43 microliter and 42.9 microliters/min, respectively. In a PCO2 range between 30 and 35 mmHg (slight hyperventilation), PVoc and Fp,oc averaged 0.38 microliters and 36.1 microliters/min, respectively; and in a PCO2 range between 20 and 25 mmHg (forced hyperventilation), they averaged 0.21 microliter and 22.8 microliters/min, respectively. All other variables were not dependent on the PCO2 level. The lowering of PVoc and Fp,oc, observed during halothane-nitrous oxide anesthesia--especially with forced hyperventilation-, may be interpreted as reduced pulsatile choroidal blood flow.(ABSTRACT TRUNCATED AT 400 WORDS)