Intravenous Anesthetics in Sepsis

Abstract

在敗血症進行的過程中，毀滅性而非保護性的過度激活之發炎反應扮演了非常重要的 角色，例如急性呼吸窘迫症候群(ARDS)、急性全身性發炎反應症候群(SIRS)、敗血性 休克、以及多重器官衰竭(multiple organ failure)等等。本篇綜合評論著重於靜脈 麻醉劑於敗血症中的多重作用機轉及可能之療效：靜脈麻醉劑於生物活體內及離體時 對細胞發炎反應的影響，靜脈麻醉劑可抑制內毒素引發之發炎細胞素活性，以及其伴 隨產生的一氧化氫、自由基、中性球等發炎物質。本篇文章同時討論了各種靜脈麻醉 劑在抑制發炎反應程度之差異，例如丙泊酚(Propofol)、K他命(ketamine)、苯二氮 平(benzodiazepines)、巴比妥鹽(barbiturates)。此外，靜脈麻醉劑的調控發炎反 應作用，對於重症加護也扮演重要角色。 Overactive inflammatory responses that destroy rather than protect are the crucial issues in the development of a spectrum of septic disease states, such as adult respiratory distress syndrome, systemic inflammatory response syndrome, septic shock, and multiple organ failure. This review focuses on an area in which alternative actions of intravenous anesthetics show much promise for sepsis: their effects on the inflammatory response and on inflammatory cells in vitro and in viva. The endotoxin-induced pro-inflammatory cytokine activity and its consequent nitric oxide generation, free radicals production and neutrophil activity are generally depressed by intravenous anesthetics. Different intravenous anesthetics, such as propofol, ketamine, benzodiazepine and barbiturates, which produce different levels of inhibition of inflammatory effects, are discussed in this article. In addition, such modulations of inflammatory responses may be of great relevance to the practice of intensive care, and intravenous anesthetics may play significant roles in this regard.