Haldemann G, Wüst H P, Hossli G, Schaer H
Anaesthesist. 1976 Nov;25(11):522-5.
The haemodynamic effect of enflurane has been examined in two groups of geriatric patients, one with and the other without preanaesthetic administration of 15 mg/kg of 1,8% dextran in lactated Ringer's solution. All the patients have been immobilized for 2 to 3 days before they were operated for an orthopaedic procedure. The administration of the colloidal solution led only to minor cardiovascular alterations: a rise of central venous pressure by 6 +/- 1 (+/- S.E.M.) cm H2O, an increase of mean arterial pressure by 6 +/- 2%, an increase of cardiac output by 10 +/- 4%. Heart rate decreased by 5 +/- 4% and total peripheral resistance by 12 +/- 5%. The cardiovascular depressant effect of enflurance was markedly attenuated by the preanaesthetic volume administration. Mean arterial pressure decreased during anaesthesia by only 16 +/- 3%, as compared with a decrease of 25 +/- 7% in the control group, cardiac output remained virtually unchanged (-3 +/- 9% vs. -37 +/- 5% in the controls) and total peripheral resistance decreased not significantly by 10 +/- 12%, while it rose in the controls by 20 +/- 8%. These findings support the hypothesis that the particular sensitivity of geriatric patients towards the depressant effects of anaesthetics is at least partially due to a compensated hypovolaemia which occurs as a physiological adaptation to immbolization. Enflurane appears as a suitable anaesthetic for geriatric patients, if proper measures for preanaesthetic volume substitution are taken.
在两组老年患者中研究了安氟醚的血液动力学效应，一组在麻醉前给予15mg/kg的1,8%乳酸林格氏液右旋糖酐，另一组未给予。所有患者在接受骨科手术前均已制动2至3天。给予胶体溶液仅导致轻微的心血管改变：中心静脉压升高6±1（±标准误）cmH₂O，平均动脉压升高6±2%，心输出量增加10±4%。心率下降5±4%，总外周阻力下降12±5%。麻醉前给予容量负荷可显著减弱安氟醚的心血管抑制作用。麻醉期间平均动脉压仅下降16±3%，而对照组下降25±7%；心输出量基本不变（-3±9% vs. 对照组-37±5%），总外周阻力下降不显著，为10±12%，而对照组升高20±8%。这些发现支持以下假设，即老年患者对麻醉药抑制作用的特殊敏感性至少部分归因于作为对制动的生理适应而发生的代偿性血容量不足。如果采取适当的麻醉前容量替代措施，安氟醚似乎是适合老年患者的麻醉药。
