Kleinschmidt S, Schellhase C, Mertzlufft F
Klinik für Anaesthesiologie und Intensivmedizin, Universitätskliniken des Saarlandes, Homburg-Saar, Germany.
Eur J Anaesthesiol. 1999 Jan;16(1):23-30. doi: 10.1046/j.1365-2346.1999.00393.x.
Gamma-hydroxybutyrate (GHB) may well be developed as an alternative for optional sedation during spinal anaesthesia. As in the case of propofol (PRO), GHB has good sedative properties associated with cardiovascular and respiratory stability. When used as a narcotic agent, recovery times are variable (e.g. > 30 min); in contrast, sedative dosages, as used in intensive care patients (e.g. 10-20 mg kg-1 h-1), result in adequate clinical recovery. The goal of the present study was to compare the clinical properties of GHB and PRO after continuous administration during spinal anaesthesia (SPA). Thirty patients (ASA I and II) received either GHB (n = 15) or PRO (n = 15) at random. Patients refusing sedation (n = 15) received 0.9% saline (control). At eight defined time points, haemodynamic (BP, HR), respiratory (RR, RMV, PaO2, SpO2, PETO2, PETCO2, VO2, VCO2) and endocrinological parameters (plasma concentrations of noradrenaline and adrenaline) as well as the clinical side-effects were assessed simultaneously. With both sedatives, the desired level of sedation was achieved. Recovery times ranged between 1.7 +/- 0.9 min with PRO and 6.1 +/- 4.9 min with GHB. GHB provided stable haemodynamic conditions without clinically relevant respiratory depression. In contrast, PRO caused a decrease in mean arterial pressure (MAP) of 15%, whereas respiratory minute volume was decreased by 53% (with periods of apnoea, SpO2 < 90%). VO2 and VCO2 correlated with respiratory minute volume (GHB, PRO, control). Plasma noradrenaline and adrenaline concentrations remained nearly constant in the GHB and control groups and declined during sedation with PRO. Both GHB and PRO are suitable for optional sedation during spinal anaesthesia. Control and recovery are acceptable for clinical purposes. It seems that GHB and PRO have similar haemodynamic, respiratory and endocrinological characteristics. Therefore, GHB may serve as an alternative for the established management of continuous sedation during SPA with PRO.
γ-羟基丁酸（GHB）很可能会被开发为脊髓麻醉期间选择性镇静的替代药物。与丙泊酚（PRO）的情况一样，GHB具有良好的镇静特性，且与心血管和呼吸稳定性相关。当用作麻醉剂时，恢复时间不一（例如>30分钟）；相比之下，重症监护患者使用的镇静剂量（例如10 - 20毫克/千克/小时）会带来足够的临床恢复效果。本研究的目的是比较脊髓麻醉（SPA）期间持续给药后GHB和PRO的临床特性。30例患者（ASA I级和II级）被随机分为接受GHB组（n = 15）或PRO组（n = 15）。拒绝镇静的患者（n = 15）接受0.9%生理盐水（对照组）。在八个确定的时间点，同时评估血流动力学参数（血压、心率）、呼吸参数（呼吸频率、每分钟通气量、动脉血氧分压、脉搏血氧饱和度、呼气末氧分压、呼气末二氧化碳分压、氧耗量、二氧化碳产量）和内分泌参数（去甲肾上腺素和肾上腺素的血浆浓度）以及临床副作用。使用两种镇静剂均达到了所需的镇静水平。恢复时间方面，PRO组为1.7±0.9分钟，GHB组为6.1±4.9分钟。GHB可提供稳定的血流动力学状况，且无临床相关的呼吸抑制。相比之下，PRO使平均动脉压（MAP）降低了15%，而每分钟通气量降低了53%（伴有呼吸暂停期，脉搏血氧饱和度<90%）。氧耗量和二氧化碳产量与每分钟通气量相关（GHB组、PRO组、对照组）。GHB组和对照组血浆去甲肾上腺素和肾上腺素浓度几乎保持恒定，而PRO镇静期间浓度下降。GHB和PRO均适用于脊髓麻醉期间的选择性镇静。对照和恢复情况对于临床目的而言是可接受的。似乎GHB和PRO具有相似的血流动力学、呼吸和内分泌特征。因此，GHB可作为SPA期间使用PRO进行持续镇静的既定管理方法的替代药物。
