Evaluation of awakening and recovery characteristics following anaesthesia with nitrous oxide and halothane fentanyl or both for brief outpatient procedures in infants

This study compared recovery characteristics and postoperative ventilatory function when halothane, fentanyl or combination of halothane and fentanyl in addition to N₂O were used for intraoperative anaesthesia in term infants undergoing hernia repair as outpatients. Sixty-six full term ASA PS I infants ages 1–12 months were studied. All received inhalation induction with N₂O, O₂ and halothane, followed by intravenous atropine and atracurium, tracheal intubation, and controlled ventilation. For anaesthesia maintenance, patients were randomized into one of three groups. Group I received 70% N₂O, 30% O₂ and halothane. Group II received 70% N₂O, 30% O₂, halothane and 2 μg·kg^?1 fentanyl. Group III received 70% N₂O, 30% O₂ and 10 μg·kg^?1 fentanyl. Awakening times were similar in all three groups, however, Group I patients had significantly shorter recovery and discharge times than those of Group II and III. None of the patients experienced postoperative apnoea or periodic breathing. One patient in Group III experienced two brief episodes of bradycardia not associated with apnoea or arterial desaturation (Spo ₂ >90% for greater than 30 s). Decreased Spo ₂ occurred less frequently in Group I (5.9%) compared to Group II (22.7%) and Group III (19.0%) patients, however, the group differences were not significant. Transcutaneous CO₂ (TcCO₂) values were not statistically different among the three groups. Pain scores were initially lower in Groups II and III, but at 120 min the differences were not significant. Postoperative apnoea was not observed in this study. Spo ₂ <90% and TcCO₂ >9 kPa (70 mmHg) was more common in infants receiving 2 and 10 μg·kg^?1 fentanyl than in infants receiving halothane and nitrous oxide anaesthesia. Infants <3 months old did not have a higher incidence of Spo ₂ <90% or significantly higher TcCO₂ values when compared to infants >3 months old. Fentanyl in doses used in this study did not prolong awakening time but did prolong recovery and discharge times in outpatient infants.     

Fentanyl and the interleukin-6 response to surgery

It has been suggested that large doses of opioids may suppress the interleukin-6 response to surgery. We examined the effects of the supplementation of inhalational anaesthesia with either 3 or 15 μg.kg⁻¹ fentanyl on the circulating interleukin-6, interleukin-8, C-reactive protein, cortisol and glucose concentrations in 16 patients undergoing pelvic surgery. In both groups, surgery evoked the expected glucose, cortisol and interleukin-6 response but no increase in interleukin-8 was detected. There were no significant differences between the two groups. We conclude that the supplementation of inhalational anaesthesia with conventional doses of opioids does not modify the cytokine response to surgery.     

人血浆中芬太尼的高效液相色谱测定方法

本文建立了测定人血浆中芬太尼的高效液相色谱方法,它具有线性范围宽,样品量小,灵敏度高,专一性强,操作简便等优点。它还可以分离和测定血浆中的奥芬太尼和苏芬太尼。适用于药代动力学的研究。     

顺-3-甲基芬太尼的4-N-丙酰基结构类似物的合成与镇痛活性及构效关系的研究

以不同电性的基团取代顺-3-甲基芬太尼中4-N-丙酰基上的乙基,合成某些顺-3-甲基芬太尼的结构类似物。药理试验结果表明,所合成的化合物均有典型的吗啡样作用。化合物3的镇痛活性略强于顺-3-甲基芬太尼。应用半经验的INDO方法对4个代表化合物进行了量子化学计算,讨论了电子结构与镇痛活性间的关系,化合物3由于氯乙烯基的引入具有与顺-3-甲基芬太尼不同的电子结构特征,氯乙烯基可能作为电子接受体参与了与受体的作用。     

Filtration of fentanyl is not the cause of the elevation of arterial blood pressure associated with post-bypass ultrafiltration in children

Modified ultrafiltration after cardiopulmonary bypass in children has been shown to be associated with an increase in arterial blood pressure. As part of a series of studies to investigate the possible causes of this blood pressure elevation, the hypothesis that if filtration was removing a significant amount of fentanyl, then the increase in blood pressure might be due to pain was proposed. Ten children, aged between 0.5 and 9.3 years (median 3.8 years), weighing 5.9 to 25..5 kg (median 15.7 kg), underwent corrective cardiac surgery (incorporating modified ultrafiltration). A standard anesthetic protocol was followed, with up to 78 μg/kg of fentanyl given prebypass for analgesia. After completion of cardiopulmonary bypass, modified ultrafiltration was commenced at 100 mL/min until a hematocrit of 35% was reached. Samples were taken of arterial blood (prefiltration, 3, 10, and 20 minutes postfiltration), the venous reservoir blood (prefiltration) and the filtrate (5 and 10 minutes into filtration). Hemodynamic data were recorded both prefiltration and postfiltration. The hemodynamic data showed the expected rise in both systemic arterial pressure and cardiac index after ultrafiltration. The plasma fentanyl concentrations did not significantly change after ultrafiltration: 1.59 to 12.39 ng/mL (median 6.27 ng/mL) prefiltration and 2.05 to 15.59 ng/mL (6.29 ng/mL) at 3 minutes, 2.22 to 12.64 ng/mL (6.87 ng/mL) at 10 minutes, and 1.83 to 11.52 ng/mL (5.85 ng/mL) at 20 minutes postfiltration. The concentration of fentanyl in the venous reservoir, 2.06 to 11.64 ng/mL (7.04 ng/mL), was not significantly different from the plasma levels. The level of fentanyl in the filtrate was significantly less than the plasma levels, 0.243 to 1.87 ng/mL (0.894 ng/mL) at 5 minutes and 0.385 to 1.688 ng / mL (0.952 ng / mL) at 10 minutes into filtration; (P < 0.02 by the Wilcoxon signed-rank method). The data show that the plasma fentanyl concentration was not significantly reduced by modified ultrafiltration. The fentanyl levels found prefiltration were maintained postfiltration, and the observed changes in systemic arterial pressure were not due to an acute fall in the plasma concentration of analgesic drug.     

舒芬太尼用于全凭静脉麻醉40例研究

目的：探讨舒芬太尼全凭静脉复合麻醉时对听觉诱发电位指数、血流动力学和术后复苏的影响.方法：40例美国标准协会（ASA）Ⅰ～Ⅱ级病人择期行胆囊切除手术,随机分为Ⅰ组（舒芬太尼组）和Ⅱ组（芬太尼组）,记录两组病人麻醉期间各时间点的听觉诱发电位指数（AEPI）值、收缩压、舒张压、心率和SpO2.结果：Ⅱ组插管后1 min、2 min的收缩压较Ⅰ组升高,而插管后1 min的心率较Ⅰ组降低（P＜0.05）;Ⅰ组插管后1 min、2 min和3 min时的AEPI值低于Ⅱ组（P＜0.05）;Ⅰ组拔管后至定向力恢复的时间较Ⅱ组长（P＜0.05）;Ⅰ组丙泊酚的用量较Ⅱ组少（P＜0.05）.结论：等效剂量的舒芬太尼较芬太尼的全凭静脉复合麻醉可以使病人达到更为合适的麻醉深度,并能使血流动力学更加稳定,同时可减少丙泊酚用量.     

小剂量芬太尼和氟哌啶静注对吸入七氟醚快速麻醉诱导的影响

为观察小剂量芬太尼和氟哌啶对吸入七氟醚快速麻醉诱导的影响。分别于吸入七氟醚后５ｍｉｎ（第１组）和吸前２ｍｉｎ（第２组）静注小剂量芬太尼（２μｇ／ｋｇ）及氟哌啶（０．１ｍｇ／ｋｇ）。结果：病人意识消失时间第１组（８７±３７）ｓ，第２组（３９±１１）ｓ（Ｐ＜０．０１）；深呼吸次数第１组（１４．０±５．３）次；第２组（４．０±０．７）次（Ｐ＜０．０１）。２组病人诱导及插管过程中循环反应相对较小。提示：在小剂量芬太尼及氟哌啶静注基础上吸入七氟醚继续行麻醉诱导其临床效果更佳，插管反应更小     

曲马多应用于全身麻醉的临床观察

目的 评估曲马多应用于全身麻醉的临床效果。方法 选择ASAI－Ⅱ级子宫手术患者60例,采用曲马多4mg/kg（T组,n＝30）或芬太尼4μg/kg（F组,n－30）,丙泊酚2．5mg/kg和维库溴铵0．1mg/kg诱导插管,术中以维库溴铵、丙泊酚（0．1－0．2）mg.kg^-1.min^-1持续静滴,曲马多（50－100）mg/h或芬太尼（0．05－0．1）mg/h维持麻醉。监测麻醉前、插管前后、切皮前及之后5、15、30、60、90min的MAP和HR,拔除气管导管后呼吸空气5、10、15、30min的SpO2,评估麻醉满意度。结果 术中麻醉效果均满意。T组在诱导插管时MAP改变不明显,而F组明显下降（P＜0．001）,两组间比较差异有显著性意义（P＜0．05）。术毕拔管后15min内呼吸空气时SpO2T组明显高于F组（P＜0．05）。结论 曲马多应用地全身麻醉效果确切,而且麻醉诱导时血流动力学改变不明显,术后呼吸抑制程度较轻。     

全麻诱导前预注芬太尼“先发镇痛”效应临床研究

目的：探讨全麻预注芬太尼的先发镇痛效应。／方法：选择40例择期全麻病人,随机分成试验组与对照组（n=20例）,术前常规用药,试验组诱导前用芬太尼5ug/kg,对照组将芬太尼改切皮后静注,术中麻醉维持相同,手术结束后病人自然清醒。术后有镇痛药使用意愿者均使用哌替啶镇痛。结果：两组病人一般情况及芬太尼总用量无显著性差异（P＞0．05）,试验组初次使用镇痛药时间明显延长（P＜0．01）,用药次数及剂量也显著少于对照组（P＜0．01）,试验组术后仅7（35％）例使用派替啶,而对照组使用哌替啶者达15（75％）例,两组差异性显著（P＜0．05）,结论：全麻前预注芬太尼具有良好的先发镇痛效应。