[Hyperoxia-induced liberation of big-endothelin into jugular venous blood of electric neurosurgical patients].
The use of hyperoxia in emergency situations is generally accepted, but the routine and uncritical application of higher oxygen concentrations is criticized. The influence of short-term application of hyperoxia on cerebral oxygenation, cerebral lactate and BIG-endothelin (BIG-ET) was studied. After approval by the Ethics Committee of the University of Leipzig, 22 patients (hyperoxia group n = 16, normoxia, control group n = 6) undergoing an elective craniotomy were included in the study. After induction of a total intravenous anaesthesia (sufentanil and propofol), a fibre-optic catheter was inserted into the bulb of the jugular vein. The inspiratory concentration of oxygen was raised from 0.4 to 1.0 for 15 minutes. Before, during and after hyperoxia, a blood gas analysis and analysis of lactate and BIG-ET were performed from arterial and jugularvenous blood. Hyperoxia caused a significant increase in jugularvenous oxygen saturation (sjO2) from 60.4 +/- 8.8% to 68.6 +/- 10.4% and jugularvenous oxygen content (cjvO2) from 10.27 +/- 2.06 vol% to 11.76 +/- 2.16 vol%. These changes were reversible after the end of hyperoxia. The jugularvenous lactate decreased significantly (9%) from 1.20 +/- 0.48 mmol/l to 1.10 +/- 0.45 mmol/l after the end of hyperoxia. Hyperoxia led to a significant increase in jugularvenous BIG-ET from 3.35 +/- 0.61 pg/ml to a maximum of 3.82 +/- 0.95 pg/ml and a decrease in the arterio-jugularvenous difference of BIG-ET from 0.19 +/- 0.53 pg/ml to a minimum -0.11 +/- 0.32 pg/ml. The changes in lactate and BIG-ET were also seen after the end of the hyperoxia. In the control group (normoxia, FiO2 0.4), no significant changes in sjO2, oxygen content, lactate and BIG-ET were observed. The increase in jugularvenous BIG-ET and the decrease in the arterio-jugularvenous difference of BIG-ET following hyperoxia indicate a higher cerebral release of BIG-ET.
Schaffranietz
L
L
Klinik und Poliklinik für Anästhesiologie und Intensivtherapie am Universitätsklinikum Leipzig (AöR). schal@medizin.uni-leipzig.de
Vetter
B
B
Rudolph
C
C
König
F
F
D000328:Adult; D000368:Aged; D000771:Anesthesia, Intravenous; D001921:Brain / Q000098:blood supply; D003399:Craniotomy; D019332:Endothelin-1; D016232:Endothelins / Q000097:blood*; D005260:Female; D006801:Humans; D018496:Hyperoxia / Q000097:blood*; D007601:Jugular Veins; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects*; D011498:Protein Precursors / Q000097:blood*; D015173:Supratentorial Neoplasms / Q000097:blood / Q000601:surgery*; D014661:Vasoconstriction / Q000502:physiology
D019332:Endothelin-1; D016232:Endothelins; D011498:Protein Precursors; D019344:Lactic Acid