The evaluation of the SVmR provides useful information for determining the optimal anesthetic depth for laryngoscopy and intubation in individual patients.

No abstract

We studied 22 female patients (ASA I or II) to investigate if laryngoscopy and intubation induced the skin vasomotor reflex (SVmR), and to compare the effects of the McCoy and Macintosh blades on the SVmR. Anaesthesia was induced with fentanyl, midazolam, vecuronium and nitrous oxide. In 11 patients, the vocal cords were seen for 3 s with the McCoy blade. Two minutes later, laryngoscopy was performed with the Macintosh blade and the trachea was intubated. In the other 11 patients, the first and second laryngoscopies, respectively, were performed with the Macintosh and McCoy blades. Laryngoscopy alone and intubation with laryngoscopy significantly reduced skin blood flow in the ring finger of all patients (P < 0.01), indicating that both procedures provoked the SVmR. The magnitude of the SVmR and haemodynamic changes did not differ significantly between the two groups.

Changes in evoked spinal cord potential (ESCP) and in local spinal cord blood flow (local SCBF) were measured simultaneously in eight dogs in the course of systemic cooling and rewarming using a water mattress. PaCO2 was maintained at 35-40 mm Hg (temperature-uncorrected values) by adjusting ventilatory volume every 1 degree C change of esophageal temperature under N2O (60%)-O2-isoflurane (1.15%) anesthesia. Local SCBF and arterial blood pressure decreased and ESCP latencies increased linearly with the decrease in body temperature to 23-24 degrees C. The conductive ESCPs (non-synaptic components) showed temporary augmentation in amplitude before eventual decrease under cooling. These showed a tendency to return to the precooling baselines after the initiation of rewarming. These results demonstrate that conductive ESCPs could be available for intraoperative monitoring of spinal function under hypothermia down to 23-24 degrees C.

The effects of intravenous administration of fentanyl on carotid sinus baroreflex control of hemodynamics were investigated in chronically instrumented rabbits. Carotid sinus baroreflex was assessed by bilateral carotid occlusion (BCO), and the responses of mean arterial pressure (MAP), heart rate (HR), mean ascending aortic flow (MAF), and total peripheral resistance (TPR) were obtained. Hemodynamic responses to BCO were examined with cumulative doses of 5, 10, and 15 micrograms/kg of fentanyl. Fentanyl did not affect MAP and TPR but reduced HR and MAF dose dependently. Fentanyl did not attenuate the MAP response to BCO significantly. In contrast, fentanyl significantly attenuated the TPR response from 0.126 +/- 0.003 to 0.104 +/- 0.005 mmHg.min-1.ml-1 and augmented the HR response from 31 +/- 2 to 47 +/- 3 beats/min in the conscious state and at 15 micrograms/kg of fentanyl, respectively. The administration of atropine after the fentanyl attenuated MAP and HR responses to 79.9 and 27.7% of those of 10 micrograms/kg of fentanyl, respectively. We suggest that these dissociated hemodynamic responses reflect the vagotonic and sympatholytic effects of fentanyl on the baroreflex pathways.