乳化异氟醚同咪唑安定的麻醉相互作用

目的 探讨咪唑安定与乳化异氟醚在大鼠麻醉中的相互作用.方法 雄性SD大鼠75只随机均分为咪唑安定组(A组)、咪唑安定+乳化异氟醚组(B组)和乳化异氟醚组(C组),以夹尾是否有叫肢或躯体发牛逃避反射作为终点指标,采用序贯法分别测定符组药物的ED50用DixonMood法计算药物的ED50,用等辐射方法和Algebraic分析法分析药物的相互作用.结果 咪唑安定和乳化异氟醚的ED50分另为(58.3±8.2)mg/kg和(1.275±0.205)ml/kg,在B组ED50分别为咪唑安定(22.5±3.2)mg/kg+乳化异氟醚(0.450±0.063)ml/kg;通过等辐射分析和代数分析显示咪唑安定同乳化异氟醚产生协同效应(P＜0.01).结论 乳化异氟醚单次给药能安伞的产生麻醉作用;乳化异氟醚同咪哗安定在麻醉效应上能产生协同效应.     

静吸复合麻醉下七氟醚与异氟醚对颅内压的影响

目的:在颅内顺应性正常神经外科病人,观察1.0 MAC七氟醚与异氟醚对颅内压的影响。方法:垂体瘤或颅咽管瘤手术病人16例,随机分为两组:A组为咪唑安定 芬太尼 1.0 MAC异氟醚;B组为咪唑安定 芬太尼 1.0 MAC七氟醚。选择L_(3～4)行蛛网膜下腔穿刺。麻醉诱导采用芬太尼-咪唑安定-阿曲库铵。插管后维持稳定30分开始吸入七氟醚(或异氟醚)。分别于麻醉前、吸入麻醉药前、达预定呼气末浓度30分内观察监测指标。结果:1.0 MAC七氟醚和异氟醚均可显著降低脑灌注压,异氟醚作用较强。吸入1.0 MAC七氟醚后颅内压首先呈显著性下降,15分后回复至基础水平。吸入1.0 MAC异氟醚后颅内压无显著性变化。结论:在颅内顺应性正常患者,1.0 MAC七氟醚和异氟醚均可安全用于神经外科麻醉。     

地氟醚和异氟醚低流量麻醉用于腹腔镜手术的比较

通过对地氟醚和异氟醚低流量麻醉用于腹腔镜下胆囊切除术的观察 ,对两药在药代动力学、苏醒方面作一比较。资料与方法一般资料　腹腔镜下胆囊切除术患者 2 6例 ,ＡＳＡⅠ～Ⅱ级 ,男 11例 ,女 15例 ,年龄 31～ 6 5岁 ,体重 5 7～ 85ｋｇ ,随机分成地氟醚组 (Ｄ组 )和异氟醚组 (Ｉ组 ) ,每组 13例。所有患者术前均无高血压病史 ,无心、肺、肝、肾功能异常。麻醉方法　患者术前 30分钟肌注阿托品 0 5ｍｇ、苯巴比妥钠 0 1ｇ。给予咪唑安定 7 5ｍｇ、芬太尼 0 1ｍｇ、异丙酚1 5ｍｇ/ｋｇ、阿曲库铵 0 5ｍｇ/ｋｇ快速诱导插管。随后Ｄ组吸入…     

异氟醚麻醉在神经外科手术中的应用：附53例报告

异氟醚具有血气分配系数低、诱导迅速、麻醉深度控制较容易、苏醒快、不燃烧、有一定的肌松作用等优点。可作为各科手术的麻醉。现将我院1985年4月-1986年11月间应用于神经外科手术麻醉53例报道如下:     

地氟醚与异氟醚在胸外科手术中麻醉效果的比较

地氟醚（Ｄｅｓｆｌｕｒａｎｅ）是一种新型卤族氟类吸入麻醉药,与异氟醚的化学结构相似,但是其理化性质和生物性质更稳定,血／气分配系数０．４２,本文就其在胸外科手术中的应用效果和异氟谜相比较。资料与方法（１）选择４０例胸外科择期手术患者（食管癌和贲门癌）ＡＳＡⅠ～Ⅱ级,随机分为两组,Ａ组２０例（男１２例,女８例）Ｂ组２０例（男１３例,女７例）,患者均无其它系统严重并发症,两组患者情况均无显著性差异（Ｐ＞０．０５）。（２）方法：两组病人均于术前半小时深部肌注安定１０ｍｇ、阿托品０．５ｍｇ,入室后以１０…     

神经外科手术异氟醚麻醉对脑电图和颅内压及血液动力学影响

目的 探讨神经外科手术中不同浓度异氟醚吸入麻醉期间脑电图（ＥＥＧ）、颅内压（ＩＣＰ）及血液动力学的变化。方法 ３０例鞍区肿瘤择期手术病人,ＡＳＡⅠ～Ⅱ级,以芬太尼、异丙酚、维库溴铵诱导插管后随机分三组,分别以０．５、１．０、１．５ＭＡＣ异氟醚维持麻醉。观察入安静平卧时、吸入氟醚浓度达指定ＭＡＣ时、切皮、锯硬膜时平均动脉压（ＭＡＰ）、心率（ＨＲ）、颅内压（ＩＣＰ）、脑电图９５％边缘频率（ＳＥＦ）及双     

异丙酚—七氟醚静吸复合麻醉用于普胸手术的体会

异丙酚－七氟醚静吸复合麻醉用于普胸手术的体会赵雾红＊黄焕森＊钟钒＊异丙酚、七氟醚均具有诱导迅速、可控性好和苏醒快的优点。近年来我们在部分普胸手术中联合应用异丙酚－七氟醚，效果满意，现报告如下。资料与方法一般资料２０例胸科择期手术，男１５例，女５例，年...     

腹部手术患者吸入七氟醚与异氟醚麻醉恢复的比较

目的比较腹部手术患者吸入七氟醚与异氟醚麻醉恢复的情况。方法全麻下行开腹手术患者40例,随机分为2组（n=20）：七氟醚组（S组）及异氟醚组（Ⅰ组）。麻醉诱导后行气管插管,机械通气。诱导后吸入纯氧,氧流量2 L/min,30min后调整为1 L/min。手术开始前,调整吸入麻醉药的呼气末浓度为1.0 MAC。麻醉维持：吸入七氟醚或异氟醚,间断静脉注射罗库溴铵和芬太尼,维持血压和心率波动幅度不超过基础值30%。缝皮结束时,停止吸入七氟醚或异氟醚,纯氧流量调整为5 L/min。记录睁眼时间（停止吸入麻醉药到睁眼的时间）、拔除气管导管时间（停止吸入麻醉药到拔除气管导管的时间）、Aldrete评分达到9分时间（从停止吸入麻醉药计时）及麻醉后恢复室（PACU）停留时间。记录吸入麻醉药用量。结果与Ⅰ组比较,S组睁眼时间、拔除气管导管时间、Aldrete评分达到9分时间及PACU停留时间缩短（P〈0.05）,吸入麻醉药的总用量和单位时间用量差异无统计学意义（P〉0.05）。结论与异氟醚比较,吸入七氟醚患者麻醉恢复较快,且麻醉恢复质量较好。     

经眶-额-颞入路显微手术切除颅咽管瘤

目的 总结经眶-额-颞入路显微手术切除颅咽管瘤的经验,探索肿瘤全切除的手术技巧。方法 采用经眶-额-颞入路显微手术切除颅咽管瘤18例。肿瘤位于鞍上7例、鞍上-第三脑室6例、鞍上-鞍内4例、第三脑室1例。12例肿瘤有钙化、13例囊性变、5例完全实质性。术中根据肿瘤的生长方向,分别从不同的间隙切除肿瘤。结果 肿瘤全切除14例,次全切除2例,部分切除2例。术后17例患者获随访,随访时间8～41个月。肿瘤全切除的14例未见肿瘤复发;次全切除和部分切除的3例于术后1个月内行辅助放疗,在随访期间肿瘤未见明显增大。Karnofsky预后评分(KPS)80～90分12例,60～70分5例,50分1例,无一例死亡。结论 经眶-额-颞入路能清楚地显露鞍区颅咽管瘤及其周围结构,减少对脑组织的牵拉和无效脑暴露。显微手术技巧是安全切除肿瘤、避免穿通动脉损伤和保护下丘脑功能的重要保障,也是手术成败的关键。     

瑞芬太尼复合异氟醚麻醉对脊柱侧凸矫形术患者术中唤醒试验的影响

目的 评价瑞芬太尼复合异氟醚吸入麻醉对脊柱侧凸矫形术患者术中唤醒试验的影响。方法 40例全麻下行脊柱侧凸矫形术患者，ASAⅠ或Ⅱ级，年龄8～20岁，随机分为2组：芬太尼组（F组）和瑞芬太尼组（R组），每组20例。低流量吸入异氟醚（新鲜气流量为1L／min，N2O：O2=1：1）维持麻醉。F组间断静脉注射芬太尼1—1．5μg／kg维持镇痛；R组静脉输注瑞芬太尼0．2／μg·kg^-1·min^-1维持镇痛，唤醒试验开始时调至0．05／Lg·kg^-1·min^-1，唤醒试验后恢复原速度至手术结束。于相应时点记录唤醒时间、呼气末异氟醚浓度（ETiso）以及平均动脉压（MAP）、心率（HR），唤醒试验中呛咳，躁动、术后恢复时间、术后恶心呕吐（PONV）发生情况及PCA吗啡用量。结果 R组较F组唤醒时间缩短，唤醒试验前HR及ETiso降低（P〈0．05），术后吗啡用量增加（P〈0．01），两组患者PONV发生情况差异无统计学意义，未见术中知晓发生。结论 静脉输注瑞芬太尼复合吸入异氟醚麻醉可缩短术中唤醒时间；与芬太尼相比，更适用于脊柱侧凸矫形术患者。     

毒扁豆碱对异氟醚麻醉大鼠炎性反应和认知功能的影响

目的探讨毒扁豆碱对异氟醚麻醉大鼠认知功能的影响及其机制。方法 2月龄SD大鼠80只,随机分为四组,每组20只。对照组(C组)吸入含有30%氧气的空氧混合气体6h;异氟醚组(I组)吸入1.4%的异氟醚6h;毒扁豆碱+异氟醚组(PI组)与毒扁豆碱组(P组)腹腔注射毒扁豆碱100μg/kg,每8小时一次,共3次。首次给药后,PI组吸入1.4%异氟醚6h;P组吸入同浓度载气6h。麻醉结束行动脉血气分析,12h后取海马组织,ELISA法检测TNF-α、IL-1β、IL-6含量,RTPCR法检测capase-3mRNA的表达。光镜下观察海马CA1区锥体细胞形态学变化。麻醉后第2~7天评估认知功能。结果四组大鼠动脉血气指标、血糖和海马TNF-α含量差异均无统计学意义。与C组和P组比较,I组和PI组大鼠海马IL-1β、IL-6含量、capase-3mRNA明显升高,第4~6天逃避潜伏期明显延长,探索时间明显缩短(P0.05)。与I组比较,PI组大鼠海马IL-1β、IL-6含量、caspase-3mRNA表达明显降低,第4~6天逃避潜伏期明显缩短,探索时间明显延长(P0.05)。结论毒扁豆碱改善了异氟醚麻醉引起的大鼠认知功能损害,其机制可能与抑制海马炎性反应及神经元凋亡有关。     

Electroencephalograms in children during isoflurane anesthesia

The electroencephalograms (EEG) of 55 children under isoflurane anesthesia were studied to elucidate any change in pattern with age. The children ranged from 1 month to 14 years of age were divided into six age groups. The standard minimum alveolar concentration (MAC) was determined in each group. Anesthesia was induced using the slow induction method, and EEG was recorded at isoflurane concentrations of 1.5 MAC in 100% oxygen, 1.0 MAC in 100% oxygen, and 1.0 MAC under administration of 66% nitrous oxide in oxygen. Ventilation was controlled mechanically (end-tidal CO₂ 35–40 mmHg). At 1.5 MAC, the incidences of burst suppression in the groups of 6 months to 6 years of age were significantly less than in groups older or younger than that age (P<0.05). Except for infants less than 6 months of age, the mean values of maximum amplitude at 1.0 MAC were two to three times of those in adults. Children 3–6 years of age showed the highest value of 427.0±83.5 μV. This paper was presented in part at the annual meeting of the Japan Society of Anesthesiology, Osaka, March, 1991.     

硬膜外注入不同浓度利多卡因对全麻病人异丙酚及异氟醚用量的影响

目的 观察在相同麻醉深度下,硬膜外注入不同浓度利多卡因对全麻病人异丙酚及异氟醚用量的影响。方法 45例择期上腹部手术病人,根据复合硬膜外用药的不同随机分为三组:生理盐水对照组(Ⅰ组)、1％利多卡因组(Ⅱ组)、2％利多卡因组(Ⅲ组),每组15例。硬膜外阻滞平面确定后麻醉诱导以25 mg/min异丙酚连续输注至病人神志消失;麻醉维持吸入异氟醚使脑电双频谱指数(BIS)值维持在50-55,硬膜外以7 ml/h泵注维持。记录异丙酚用量、异氟醚呼气末浓度(ETiso)及BIS、听觉诱发电位指数(AAI)。结果 病人意识消失时异丙酚用量:Ⅰ组(1.7±0.4)mg/kg、Ⅱ组(1.2±O.3)mg/kg和Ⅲ组(1.0±0.3)mg/kg,Ⅲ组和Ⅱ组异丙酚用量比Ⅰ组明显减少(P<0.01)。ETiso分别为Ⅰ组(0.85±0.10)％,Ⅱ组(0.65±0.06)％,Ⅲ组(0.57±0.12)％,Ⅱ组、Ⅲ组比Ⅰ组和Ⅲ组比Ⅱ组明显降低(P<0.01或0.05)。结论 维持相同的麻醉深度下,硬膜外注入1％利多卡因组比2％利多卡因组既能减少全麻药的用量,又能保持循环的相对稳定。     

右美托咪啶与咪达唑仑复合舒芬太尼用于肝癌微波治疗术患者麻醉效果的比较

目的 比较右美托咪啶与咪达唑仑复合舒芬太尼用于肝癌微波治疗术患者麻醉的效果.方法 择期行经皮肝穿刺微波治疗术的肝癌患者40例,男性,ASA分级Ⅱ级,年龄35～62岁,体重45～70 kg,采用随机数字表法,将其随机分为2组(n=20):咪达唑仑组(Ⅰ组)和右美托咪啶组(Ⅱ组).Ⅰ组静脉注射咪达唑仑负荷量40μg/kg,然后静脉输注咪达唑仑40μg·kg-1·h-1;Ⅱ组静脉注射右美托眯啶负荷量1μg/kg,然后静脉输注右美托咪啶0.5μg·kg-1·h-1.两组药物负荷量均用生理盐水稀释至20ml,注射时间均为10 min.负荷量注射完毕后5 min时,静脉注射舒芬太尼负荷量0.2μg/kg,然后采用舒芬太尼行PCIA,背景输注速率0.1μg·kg-1·h-1,PCA量0.1μg/kg,锁定时间3 min.舒芬太尼负荷量注射完毕后2 min开始手术.记录术中心动过缓、心动过速、低血压、高血压和呼吸抑制的发生情况;记录舒芬太尼的PCA总按压次数和有效按压次数.结果 两组心动过缓、心动过速、低血压和高血压的发生率比较差异无统计学意义(P＞0.05);与Ⅰ组比较,Ⅱ组呼吸抑制发生率降低,舒芬太尼PCA总按压次数和有效按压次数减少(P＜0.05).结论 肝癌微波治疗术患者右美托咪啶复合舒芬太尼的麻醉效果优于咪达唑仑复合舒芬太尼.

Abstract：

Objective To compare the efficacy of anesthesia with dexmedetomidinc and midazolam combined with sufentanil in patients undergoing microwave coagulation therapy for liver cancer. Methods Forty ASA Ⅱ male patients, aged 35-62 yr, weighing 45-70 kg, scheduled for percutaneous microwave coagulation therapy,were randomly divided into 2 groups ( n = 20 each): midasolam group ( group Ⅰ ) and dexmedetomidine group ( group Ⅱ ). A loading dose of midazolam 40 μg/kg ( in normal saline 20 ml) was given intravenously over 10 min,followed by midasolam infusion at 40 μg·kg-1 ·h-1 in group Ⅰ . A loading dose of dexmedetomidine 1 μg/kg (in normal saline 20 ml ) was given intravenously over 10 min, followed by dexmedetomidine infusion at 0.5 loading dose of sufentanil 0.2 μg/kg was given, and then patient-controlled intravenous anesthesia with sufentsnil (background infusion 0.1 μg·kg-1 ·h-1 , bolus dose 0.1 μg/kg, lockout interval 3 min) was used. The operation was started 2 min after administration of the loading dose of sufentanil. Bradycardia, tachycardia, hypotension, hypertensinn and respiratory depression were recorded. The number of attempts and successfully delivered doses was also recorded. Results There was no significant difference in the incidence of bradycardia, tachycardia, hypotension and hypertension between the two groups ( P ＞ 0 .05). The incidence of respiratory depression was significantly lower, and the number of attempts and successfully delivered doses was smaller in group Ⅱ than in group Ⅰ ( P ＜ 0.05). Conclusion The efficacy of anesthesia with dexmedetomidine and sufentanil is better than that of anesthesia with midazolam and sufentanil in patients undergoing microwave coagulation therapy for liver cancer.     

The effect of craniotomy location on postoperative pain and nausea

Purpose.At least one retrospective study has suggested that the need for postoperative control of pain and nausea depends on the location of the cranial surgery. This prospective study was performed to examine the hypothesis that patients who have had infratentorial craniotomy experience more severe pain and more frequent nausea than those with supratentorial procedures. Methods.We compared postoperative outcomes in 28 patients with infratentorial craniotomy, 53 with supratentorial craniotomy, and 47 with complex spinal cord surgery (the control group). Anesthesia was standardized for all three groups and the concentration of isoflurane was titrated to keep mean arterial pressure within 30% of preoperative values. Severity of pain and frequency of nausea and vomiting were recorded for 24h after surgery. Pain was assessed with a verbal pain score scale of 0–10, with 10 being the worst pain imaginable. Data were collected for 24h postoperatively. Results.Because nausea and pain diminish drastically 2h after surgery, pairwise differences were assessed at each point within the first 2h. Within 30min of extubation, median pain scores in the supratentorial and spine groups rose to 2 and in the infratentorial group to 5. The statistical differences between groups were not significant (P > 0.06) by logistic regression. Also, the incidence of nausea was not significantly different (57% supratentorial, 57% spine, 67% infratentorial; P = 0.62) by Dunns procedure. Conclusion.There were no significant differences in the severity of pain or the frequency of nausea based on the craniotomy site.     

异丙酚-异氟醚复合控制性降压用于颅脑手术的观察

目的 观察异丙酚－异氟醚复合控制性降压麻醉下实施颅脑手术的效果。方法 ３０例病人在吸入异氟醚０．６－１．０ＭＡＣ基础上，同时静注异丙酚６－１０ｍｇ．ｋｇ＾－１．ｈ＾１，当手术需要降压时，增快异丙酚输入速度至３０－４０ｍｇ．ｋｇ＾－１．ｈ＾－１，同时监测降压程度及停药后血压恢复情况。     

Effects of sevoflurane anesthesia combined with epidural block on renal function in the elderly: comparison with isoflurane

Purpose. Renal function declines with age, but little is known about the renal effects of the inhaled anesthetic sevoflurane in the elderly. We therefore compared the renal effects of sevoflurane and isoflurane anesthesia in elderly patients. Methods. Thirteen patients aged ≥70 years undergoing gastrectomy with epidural anesthesia combined with general anesthesia were randomly assigned to receive either sevoflurane (n = 7) or isoflurane (n = 6). Dopamine (3–5 μg·kg⁻¹·min⁻¹) was administered to all patients. Blood and urine samples were collected before, during, and after anesthesia. Serum and urinary inorganic fluoride was measured, and renal function tests were performed. Results. Serum inorganic fluoride was significantly elevated in both groups. The production of inorganic fluoride was significantly greater in the sevoflurane group, but the level did not exceed 50 μmol·l⁻¹ in any patient. No abnormalities were observed in blood urea nitrogen (BUN), serum creatinine, or urine volume in either group. The albumin excretion index increased during anesthesia and decreased after anesthesia in both groups. Creatinine clearance was unchanged in the sevoflurane group but fluctuated during and after anesthesia in the isoflurane group. α₁-Microglobulin (MG), β₂-MG, and urinary N-acetyl-β-d-glucosaminidase (NAG) excretion increased up to 3 h after anesthesia, and α₁-MG and β₂-MG excretion increased on postanesthesia day 3. Conclusion. In both groups, glomerular and tubular function were transiently affected, but no abnormalities were found in routine laboratory tests, suggesting that neither isoflurane nor sevoflurane in combination with dopamine and epidural anesthesia seriously affects renal function in the elderly. Received for publication on October 23, 1998; accepted on October 27, 1999     

Management of anesthesia in awake craniotomy

The awake craniotomy technique was originally introduced for the surgical treatment of epilepsy and has subsequently been used in patients undergoing surgical management of supratentorial tumors, arteriovenous malformation, deep brain stimulation, and mycotic aneurysms near critical brain regions. This surgical approach aims to maximize lesion resection while sparing important areas of the brain (motor, somatosensory, and language areas). Awake craniotomy offers great advantages with respect to patient outcome. In this type of procedure, the anesthetist's goal is to make the operation safe and effective and reduce the psychophysical distress of the patient. Many authors have described different anesthetic care protocols for awake craniotomy based on monitored or general anesthesia; however, there is still no consensus as to the best anesthetic technique. The most commonly used drugs for awake craniotomies are propofol and remifentanil, but dexmedetomidine is beginning to be used more commonly outside of Europe. Personal experience, careful planning, and attention to detail are the basis for obtaining good awake craniotomy RESULTS: Additional studies are necessary in order to optimize the procedure, reduce complications, and improve patient tolerance. The aim of this review is to present a thorough report of the literature, with particular attention to neuro-oncology surgery.