麻醉期间和麻醉后七氟醚对人类肉眼脑脊液流量的损害。

IF 9.1 1区医学 Q1 ANESTHESIOLOGY

Anesthesiology Pub Date : 2025-01-08 DOI:10.1097/ALN.0000000000005360

Juliana Zimmermann, Christian Sorg, Leander Müller, Franziska Zistler, Viktor Neumaier, Moritz Bonhoeffer, Andreas Ranft, Daniel Golkowski, Josef Priller, Claus Zimmer, Rüdiger Ilg, Christine Preibisch, Gerhard Schneider, Rachel Nuttall, Benedikt Zott

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引用次数: 0

摘要

背景：根据淋巴系统的模型，脑脊液（CSF）的定向流动是脑废物清除的驱动因素。在睡眠中，淋巴运输增强，但麻醉对其影响尚不清楚。动物研究表明，不同的麻醉药有部分相反的效果，但在人类身上却缺乏相应的结果。因此，本研究旨在探讨七氟醚麻醉对麻醉期间和麻醉后人类脑脊液流量的影响。方法：利用功能磁共振成像（fMRI）实验数据，对16名健康受试者进行了2vol%七氟烷单麻醉前、麻醉中和麻醉后45分钟的脑灰质血氧水平依赖（BOLD）信号与基底池脑脊液流量的关系，并通过fMRI信号波动指标进行了关联。具体而言，脑脊液流量通过脑脊液fMRI信号幅度测量，脑灰质（gGM）功能连通性通过区域间脑灰质fMRI Spearman秩相关的中位数测量，脑灰质-脑脊液基底池耦合通过fMRI信号的Spearman秩相关测量。结果：麻醉降低了脑池脑脊液峰谷振幅（Mdn-diff的中位数差值为1.00,95% CI [0.17 1.83], p = 0.013），破坏了皮层基于bold - fmri的整体连接（Mdn-diff = 1.5, 95% CI [0.67, 2.33], p < 0.001）和整体灰质(gGM)-脑脊液耦合（Mdn-diff = 1.19, 95% CI [0.36, 2.02], p = 0.002）。值得注意的是，全身连通性（Mdn-diff = 0.94, 95% CI [0.11, 1.77], p = 0.022）和gGM-CSF耦合（Mdn-diff = 1.06, 95% CI [0.23, 1.89], p = 0.008）在麻醉恢复后持续受损。结论：总的来说，我们的数据表明，七氟醚通过破坏相干gGM活性来损害宏观脑脊液流动。这种效果在恢复意识后至少会持续一段时间。未来的研究需要阐明这是否有助于术后神经认知症状的出现，特别是在老年患者或痴呆患者中。

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Impaired macroscopic CSF flow by sevoflurane in humans - both during and after anesthesia.

Background: According to the model of the glymphatic system, the directed flow of cerebrospinal fluid (CSF) is a driver of waste clearance from the brain. In sleep, glymphatic transport is enhanced, but it is unclear how it is affected by anesthesia. Animal research indicates partially opposing effects of distinct anesthetics but corresponding results in humans are lacking. Thus, this study aims to investigate the effect of sevoflurane anesthesia on CSF flow in humans, both during and after anesthesia.

Methods: Using data from a functional magnetic resonance imaging (fMRI) experiment in 16 healthy human subjects before, during, and 45 minutes after sevoflurane mono-anesthesia of 2vol%, we related grey matter blood-oxygenation-level dependent (BOLD) signals to CSF flow, indexed by fMRI signal fluctuations, across the basal cisternae. Specifically, CSF flow was measured by CSF fMRI signal amplitudes, global grey matter (gGM) functional connectivity by the median of inter-regional GM fMRI Spearman rank correlations, and gGM-CSF basal cisternae coupling by Spearman rank correlations of fMRI signals.

Results: Anesthesia decreased cisternal CSF peak-to-trough amplitude (median difference Mdn-diff = 1.00, 95% CI [0.17 1.83], p = .013), disrupted the global, cortical BOLD-fMRI-based connectivity (Mdn-diff = 1.5, 95% CI [0.67, 2.33], p < 0.001) and, global grey matter (gGM)-CSF coupling (Mdn-diff = 1.19, 95% CI [0.36, 2.02], p = 0.002). Remarkably, the impairments of global connectivity (Mdn-diff = 0.94, 95% CI [0.11, 1.77], p = 0.022) and gGM-CSF coupling (Mdn-diff = 1.06, 95% CI [0.23, 1.89], p = 0.008) persisted after re-emergence from anesthesia.

Conclusions: Collectively, our data show that sevoflurane impairs macroscopic CSF flow via a disruption of coherent gGM activity. This effect persists, at least for a short time, after regaining consciousness. Future studies need to elucidate whether this contributes to the emergence of postoperative neurocognitive symptoms, especially in older patients or those with dementia.

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来源期刊

Anesthesiology 医学-麻醉学

CiteScore

10.40

自引率

5.70%

发文量

542

审稿时长

3-6 weeks

期刊介绍： With its establishment in 1940, Anesthesiology has emerged as a prominent leader in the field of anesthesiology, encompassing perioperative, critical care, and pain medicine. As the esteemed journal of the American Society of Anesthesiologists, Anesthesiology operates independently with full editorial freedom. Its distinguished Editorial Board, comprising renowned professionals from across the globe, drives the advancement of the specialty by presenting innovative research through immediate open access to select articles and granting free access to all published articles after a six-month period. Furthermore, Anesthesiology actively promotes groundbreaking studies through an influential press release program. The journal's unwavering commitment lies in the dissemination of exemplary work that enhances clinical practice and revolutionizes the practice of medicine within our discipline.