嗜酒者丙泊酚静脉全麻药量及效应的临床观察

目的 观察嗜酒对丙泊酚用药量和麻醉效果的影响.方法 嗜酒者与非饮酒者各40例,静注芬太尼0.002 mg/kg后继以4 mg·kg-1·min-1的速度缓慢静注丙泊酚,直至睫毛反射消失.记录丙泊酚用量、意识恢复时睁眼、对答和自行离去时间、各监测指标及不良反应.结果 两组丙泊酚用量[(1.88±0.36)mg/kg与(1.59±0.35)mg/kg]、自行离去时间[(24.43±5.55)min与(27.78±4.65)min]、RR[(9.13±1.27)次/分与(10.88±1.40)次/分]、SpO2[(96.93±2.08)%与(97.90±0.98)%],差异均有统计学意义(P<0.01).嗜酒者的咳嗽反应、舌根后坠、检查时肢体运动的比例较高,但恶心、呕吐的发生率低.结论 嗜酒者丙泊酚诱导剂量显著增加,恢复时间短,呼吸抑制增强,恶心呕吐发生率低.     

Effect-compartment equilibrium rate constant (k eo) for propofol during induction of anesthesia with a target-controlled infusion device

The effect-compartment concentration (C_e) of a drug at a specific pharmacodynamic endpoint should be independent of the rate of drug injection. We used this assumption to derive an effect-compartment equilibrium rate constant (k_eo) for propofol during induction of anesthesia, using a target controlled infusion device (Diprifusor). Eighteen unpremedicated patients were induced with a target blood propofol concentration of 5 μg · ml⁻¹ (group 1), while another 18 were induced with a target concentration of 6 μg · ml⁻¹ (group 2). The time at loss of the eyelash reflex was recorded. Computer simulation was used to derive the rate constant (k_eo) that resulted in the mean C_e at loss of the eyelash reflex in group 1 being equal to that in group 2. Using this population technique, we found the k_eo to be 0.57 min⁻¹. The mean (SD) effect compartment concentration at loss of the eyelash reflex was 2.39 (0.70) μg · ml⁻¹. This means that to achieve a desired C_e within 3 min of induction, the initial target blood concentration should be set at 1.67 times that of the desired C_e for 1 min, after which it should revert to the desired concentration.     

Abnormally low bispectral index and isoelectric electroencephalogram observed after administration of small doses of propofol during induction of anesthesia

We describe a case in which an unexpectedly, abnormally low bispectral index value (BIS = 4) and an almost isoelectric electroencephalogram (EEG) pattern were observed during typical induction of anesthesia with propofol. Starting 2 min after the beginning of propofol administration (1.26 mg kg⁻¹), the EEG recordings showed burst and suppression pattern for the next 12 min. The EEG during this period was characterized by gradual prolongation of suppression periods until the appearance of the isoelectric line. After that, burst activity returned and eventually the burst suppression pattern disappeared. We excluded the possibility of ischemic brain damage, and the evidence increasingly points toward a greater sensitivity to propofol. The findings described in this case report support the thesis that there is a wide variability in the responses of patients to propofol that cannot be detected without continuous monitoring of cortical electrical activity.     

脑状态指数在七氟醚或丙泊酚诱导时的变化

目的 观察七氟醚或丙泊酚麻醉时脑状态指数(CSI)的变化.方法 30例腹腔镜手术患者随机均分成七氟醚组(S组)和丙泊酚组(P组).麻醉诱导:S组吸入2%的七氟醚,每隔1分钟增加1%;P组每隔1分钟重复给予15 mg丙泊酚,直至患者意识消失.记录患者诱导期的CSI数值,并对患者的镇静程度采用警觉/镇静评分(OAA/S)标准评分.结果 S组与P组术前CSI基础值差异无统计学意义,随着麻醉的加深,两组的CSI数值均明显下降(P<0.01),至OAA/S 1分时S组与P组的CSI数值较OAA/S 5分时明显下降(P<0.05或P<0.01),S组与P组的CSI与OAA/S的相关系数r分别为0.843和0.812.结论 CSI监测可反映七氟醚或丙泊酚麻醉时的麻醉深度.     

麻醉诱导期间异丙酚与利多卡因的相互作用

目的探讨麻醉诱导期间不同利多卡因浓度对睫毛反射、意识消失时异丙酚血药浓度和心血管系统的影响。方法选择38例择期手术病人应用微机控制靶控输注利多卡因维持不同目标浓度(Ct)，其后从另一接口输注异丙酚，逐渐增加异丙酚目标浓度直至意识消失。根据利多卡因目标浓度将病人分为5组，分别为A组Oug·ml     

异丙酚对颅内压的影响

目的：评价异丙酚对神经外科病人颅内压的影响。方法：１３例颅内胶质瘤成年病人ＡＳＡⅠ～Ⅱ级，择期行开颅手术。在麻醉诱导时，静注异丙酚２ｍｇ／ｋｇ。分别于注药前、后１、２、３、５、７、１０、１５和２０分钟，观察收缩压（ＳＰ），舒张压（ＤＰ），平均动脉压（ＭＡＰ），心率（ＨＲ），脑灌注压（ＣＰＰ），颅内压（ＩＣＰ）的变化。颅内压监测采用腰蛛网膜下腔置管直接测压。结果：静注异丙酚后ＳＰ，ＭＡＰ，ＣＰＰ显著降低（１５．１８±２．２１ｋＰａ降至１３．４４±１．５６ｋＰａ，１１．３３±２．１４ｋＰａ降至９．５４±１．７０ｋＰａ，９．０５±２．４６ｋＰａ降至７．９７±２．１４ｋＰａ）但是随着时间的延长在２０分钟内恢复至基础水平，ＤＰ、ＨＲ给药前后无明显变化，ＩＣＰ给药后明显下降且在观察期内无回升趋势。结论：异丙酚能降低病人的颅内压，适用于神经外科麻醉，对颅内压增高病人应适当调整用量。     

全麻诱导中右旋美托咪定的镇静效应及对丙泊酚用量的影响

目的研究全麻诱导中右旋美托咪定（Dex）的镇静效应及对丙泊酚用量的影响。方法选择30例择期全麻手术患者,ASAⅠ或Ⅱ级,随机分成Dex组（D组）和对照组（C组）,每组15例。D组以1μg/kgDex稀释成10ml、C组以生理盐水分别静脉泵注10min,给药后20min泵注丙泊酚0.4mg·kg-1.min-1,托下颌无体动时给予芬太尼1μg/kg和罗库溴铵0.6mg/kg,1.5min后进行气管内插管。记录用药前（T0）、用药后5min（T1）、10min（T2）、20min（T3）的反应指数（RE）、状态指数（SE）、Ramsay评分。记录睫毛反射消失时丙泊酚最小诱导量和丙泊酚诱导总用量。结果 T1～T3时D组SE、RE显著低于C组和T0时（P〈0.01）,Ramsay评分明显高于C组和T0时（P〈0.01）。D组丙泊酚最小诱导量和诱导总量明显低于C组（P〈0.01）。结论 Dex1μg/kg诱导可以产生明显的镇静效应,无呼吸抑制作用,可减少诱导时丙泊酚用量。     

胸阻抗法监测咪唑安定及丙泊酚静脉全麻诱导过程中血流动力学变化

目的研究丙泊酚及咪唑安定静脉全麻诱导过程中对病人血流动力学变化的影响。方法年龄18~65岁、ASAⅠ或Ⅱ级的择期手术病人50例,随机分成丙泊酚组(A组)和咪唑安定组(B组),每组25例,分别以丙泊酚1.5mg/kg或咪唑安定0.2mg/kg进行诱导,用胸阻抗法监测麻醉诱导前(T0)、插管前(T1)、插管即刻(T2)、插管后1min(T3)、3min(T4)、5min(T5)时的体循环阻力(SVR)、左心作功(LCW)、心排血量(CO)、心脏指数(CI)、SBP、DBP和HR的变化。结果两组病人在全麻诱导过程中SBP、SVR、CO、LCW差异无统计学意义,B组HR在T1、T2、T4及T5时明显快于A组(P<0.05或P<0.01)。结论0.2mg/kg咪唑安定与1.5mg/kg丙泊酚进行全麻诱导对血流动力学的影响基本一致。     

异丙酚麻醉诱导期间动脉和颈内静脉球部血药浓度的变化

目的 探讨患者意识消失时的异丙酚血药浓度与给药速率的关系。方法 ASA　Ⅰ～Ⅱ级无心脑肝肾功能异常的择期手术患者14例,随机分A、B两组,静注异丙酚速率分别为6、12mg·kg-1·h-1,持续30min。均于给药前即刻、给药后1、2、4、6、8、10、15、20、25、30min以及意识消失点同步采集桡动脉及颈内静脉球部血各1ml,用高效液相色谱-荧光法检测血浆异丙酚的血药浓度。结果意识消失时的异丙酚用量组间无统计学差异（1.15和1.20mg·kg-1,P>0.05）,A组异丙酚麻醉意识消失时间明显长于B组（697和 313s,P<0.01）,意识消失时A组动脉血药浓度（Ca）和颈内静脉球部血药浓度（Cjvb）均显著低于B组（Ca:1.64和2.78μg·ml1、Cjvb:1.18和1.69μg·ml-1,P<0.05或0.01）。从开始输注到意识消失时的动静脉血药浓度-时间曲线下面积差（AUCa-v）组间无显著性差异（4.56和4.23μg·ml-1·min-1,P>0.05）。结论 非稳态条件下异丙酚的靶血浆浓度不能预测患者意识消失;异丙酚麻醉诱导意识消失时的动脉和静脉血药浓度与给药速率有关;但意识消失时,两组异丙酚静注剂量及脑摄取量无差异。     

丙泊酚静脉麻醉后患者的梦境回忆及影响因素

目的 研究丙泊酚静脉麻醉下梦境回忆的发生情况以及影响因素.方法 选择无痛苦胃镜或肠镜检查的非住院患者160例.静脉推注芬太尼和丙泊酚,待患者睫毛反射消失、OAA/S评分达0分开始进镜检查.检查结束后待患者OAA/S评分达5分后进行问卷调查.问卷调查内容包括改良Liker梦境内容评分量表、Brice标准提问以及患者检查前睡眠、精神状况等.结果 梦境回忆发生率为49.06%.较高的文化程度、恢复时间≤60 s、术前了解无痛检查、平常高梦境回忆频率是发生梦境回忆的独立预测因素(P<0.05).年龄、性别、ASA分级、检查部位、丙泊酚用量、检查时间、既往是否有无痛检查史、术前情绪状态、术前1月内失眠情况对梦境回忆的发生率无明显影响(P>0.05).结论 在丙泊酚镇静麻下实施内镜检查的患者,术后梦境回忆是一个常见的现象.此梦境的发生是一个神经生理一心理活动参与的过程,药物对中枢神经的药理作用起主导作用.     

Titration of propofol infusion using processed electroencephalogram during combined general and spinal anesthesia

Purpose

To determine the necessary mean infusion rate of propofol during combined nitrous oxide (N₂O) and propofol spinal anesthesia by using the processed electroencephalogram (pEEG).

Methods

Twelve elective gynecological patients were monitored by a Dräger pEEG monitor under N₂O and propofol spinal anesthesia. To make it easier to detect an inadequate depth of anesthesia, muscle relaxants were not given and the patients breathed spontaneously through a laryngeal mask airway. Manual step-down infusion of propofol was employed to provide intraoperative hypnosis. Propofol infusion was titrated to maintain cardiorespiratory parameters within 20% of baseline and the 90th percentile of the spectral edge frequency (SEF 90) of the pEEG between 10 and 13.5 Hz.

Results

The mean (SD) induction dose of propofol was 2.9 (0.4) mg·kg^?1. The mean (SD) maintenance infusion rate was 4.2 (0.5) mg·kg^?1·h^?1. The mean (SD) time from the end of propofol infusion to the opening of the patient's eyes was 5.4 (2.0) min. No gross movements or intraoperative awareness was recognized. The mean (SD) SEF 90 during the maintenance of anesthesia was 12.2 (1.5) Hz, which increased significantly to 16.2 (1.9) Hz at 1 min before the patients opened their eyes in reponse to verbal commands.

Conclusion

Titration of propofol infusion using SEF during combined general and spinal anesthesia provided a rapid recovery without any clinical signs of inadequate anesthesia.     

丙泊酚伍用麻黄碱在胃镜检查中的应用

目的观察丙泊酚伍用小剂量麻黄碱在胃镜检查中的麻醉与质量.方法选择100例胃镜检查患者,随机分为观察组（A组）和对照组（B组）,每组50例,用丙泊酚2.4 mg/kg加盐酸利多卡因0.8 mg/kg行静注诱导.A组在2～5 min视BP波动幅度追加麻黄碱0.08～0.15 mg/kg.监测BP、HR、SpO2,比较两组患者麻醉与清醒时间和质量.结果B组BP下降者占27%,SpO2〈95%者达5%;A组99%患者BP、HR、SpO2稳定,清醒时间较B组平均短1.5 min,清醒质量好.结论小剂量麻黄碱能防治丙泊酚麻醉用于胃镜术中的循环波动,并能提高清醒质量.     

异丙酚麻醉诱导期间不同剂量瑞芬太尼对病人气管插管心血管反应的影响

目的比较异丙酚麻醉诱导期间不同剂量瑞芬太尼对病人气管插管心血管反应的影响，寻找瑞芬太尼复合异丙酚气管插管的合适剂量。方法择期行腹腔镜胆囊切除术病人36例，ASAⅠ或Ⅱ级，年龄20～65岁，随机分为3组（n=12）：瑞芬太尼1、1．5、2μg／kg分别为复合异丙酚1．5μg／kg组（Ⅰ、Ⅱ、Ⅲ组）。依次静脉注射咪唑安定0．03mg／kg、异丙酚1．5mg/kg、维库溴铵0．1mg／kg以及瑞芬太尼麻醉诱导，2min后气管插管，进行机械通气，呼吸频率12次／min，潮气量8～10ml／kg，维持呼气末二氧化碳分压35～45mmHg。持续监测血压（平均动脉压、舒张压、收缩压）、心率（HR）以及听觉诱发电位指数（AAI），并记录病人有无气管插管时呛咳和肌肉强直、术中知晓等反应。结果与基础值比较，三组气管插管前即刻血压及Ⅲ组气管插管后即刻舒张压均降低，Ⅲ组气管插管后即刻血压低于Ⅰ组（P〈0．05）；HR组间及组内比较差异无统计学意义；三组间AAI差异无统计学意义。结论异丙酚1．5mg／kg麻醉诱导期间瑞芬太尼1或1．5μg／kg是病人气管插管时的合适剂量。     

两种浓度丙泊酚用于腹腔镜胆囊切除术患者药物效应比较

目的 比较相同剂量1％丙泊酚与2％丙泊酚用于腹腔镜胆囊切除术患者的药物效应及达到相同药物效应时的药物用量.方法 选择拟行腹腔镜胆囊切除术患者100例,采用随机数字表法分为两组(每组50例):输注1％丙泊酚组(Ⅰ组)、输注2％丙泊酚组(Ⅱ组).诱导剂量均为2 mg/kg,整个麻醉过程中用Narcotrend麻醉深度监护仪监测麻醉深度,诱导完成后根据Narcotrend指数调整两组丙泊酚的泵速.观察患者Narcotrend指数下降到36的时间、意识消失时间、监测诱导开始15 min内MAP和HR下降百分比、丙泊酚第1小时用量及停药至Narcotrend指数恢复到65的时间.结果 两组患者意识消失时间及Narcotrend指数下降到36的时间Ⅰ组分别为(115±45)s和(136±54)s,Ⅱ组分别为(156±60)s和(183±61)s,Ⅰ组短于Ⅱ组(P＜0.05).丙？白酚使用总量和丙泊酚第1小时用量Ⅰ组分别为(41±15)ml和(36±10) ml,Ⅱ组的2倍用药量分别为(53±18) ml和(46±15)ml,Ⅱ组的2倍用药量大于Ⅰ组用药量(P＜0.05).结论 2％丙泊酚麻醉药用量的2倍大于1％丙泊酚,而不是等量的,这说明1％丙泊酚的药效可能强于2％丙泊酚,2％丙泊酚经济效益相对较低.     

接受术前药后全麻病人诱导用异丙酚量-效关系的研究

目的 测定全麻病人接受术前用药后异丙酚的诱导剂量,方法 选择择期手术病人９０例,随机分为６个异丙酚剂量组,每组１５例,诱导前３０分钟给予哌替啶５０ｍｇ,阿托品０．５ｍｇ诱导前用药为氟哌啶醇１ｍｇ,芬太尼１μｇ／ｋｇ,将唤之不能睁眼作为麻醉的最终效应点,得出剂量效应回归曲线。结果 异丙酚的ＥＤ５０和ＥＤ９０分别为０．６７ｍｇ／ｋｇ（０．５９～０．７６ｍｇ／ｋｇ）和１．１１ｍｇ／ｋｇ（０．９８～１．２     

Behavior of the histamine level in induction of anesthesia with propofol and methohexital

In a study of the effect of intravenous anesthetics on plasma histamine levels, propofol and methohexital were administered to patients. Histamine determination was performed using an improved fluometric method specific for imidazole derivatives. As a primary step, the plasma histamine concentration was determined in 60 healthy, fasting probands and used as a comparative value. The mean value obtained from 60 examinations was 0.38 +/- 0.12 ng/ml, the median value was 0.37 ng/ml (Table 1). The next step consisted in determination of plasma histamine values in 20 patients 1 h following premedication with fentanyl. In this group, the mean value was 0.33 +/- 0.11 ng/ml, the median value 0.316 ng/ml (Table 2). In another 20 patients the plasma histamine concentration was determined 1 h following intramuscular injection of 1.4 microgram fentanyl +0.07 mg/kg droperidol (Thalamonal). In this group, the mean value was 0.373 +/- 0.11 ng/ml and the median value was 0.736 ng/ml. Subsequently, the effect of 2.5 mg/kg propofol (Disoprivan) or 1 mg/kg methohexital (Brevimytal) on plasma histamine levels was examined in a randomized, prospective study in 22 patients of ASA class I and II (Table 3, Fig. 2). Two minutes prior to injection of the test substances and 2, 4, 8, and 13 min following injection, plasma histamine levels, blood pressure, and heart rate were examined. In both groups, no changes in plasma histamine levels were observed during the period of examination. Comparison of the individual time columns within a group as well as intergroup comparisons revealed no statistically significant differences in either the t test or the Wilcoxon-Mann-Whitney U test.(ABSTRACT TRUNCATED AT 250 WORDS)     

The influence of cold on pain during intravenous induction of anaesthesia with propofol in children

Pain on injection and quality of induction were compared in 74 children (5–12 years) randomly assigned to receive either 5 mg·kg^?1 of cold propofol (group A), 5 mg·kg^?1 of cold propofol mixed with lignocaine 1% (group B) or 5 mg·kg^?1 of propofol at room temperature (22–23°C) mixed with lignocaine 1% (group C). The group receiving cold propofol had to be stopped due to a very high incidence of pain (70%). The incidence of pain on injection was 3% in group B and 17% in group C (not significant). Quality of induction and side-effects were similar in the two groups.     

Evaluation of histamine-releasing property of propofol in whole bloodin vitro

We examined the property of emulsion form of propofol (ICI 35 868) to release histamine in whole blood in vitro. Heparinized whole blood from 10 healthy volunteers were incubated with medium and propofol at the final concentration of 0, 1, 10 and 100µg·ml^–1. The concentration of histamine in supernatant fluid after incubation was measured by radioimmunoassay. Histamine release was expressed as the percentage of the concentration of histamine released into supernatant fluid relative to the total cellular histamine content, which was yielded by destroying cell components in the whole blood. Histamine release in the presence of propofol at the concentrations of 1, 10 and 100µg·ml^–1 were almost the same as histamine release in the absence of propofol. We conclude that emulsion form of propofol has no property to release histamine in whole blood in vitro.(Mitsuhata H, Shimizu R: Evaluation of histamine-releasing property of propofol in whole blood in vitro. J Anesth 7: 189–192, 1993)