监测麻醉护理期间丙泊酚靶控输注的临床评估

Clinical assessment of target-controlled infusion of propofol during monitored anesthesia care.

作者信息

Casati A, Fanelli G, Casaletti E, Colnaghi E, Cedrati V, Torri G

机构信息

University of Milan - Department of Anesthesiology, IRCCS H. San Raffaele, Italy.

出版信息

Can J Anaesth. 1999 Mar;46(3):235-9. doi: 10.1007/BF03012602.

DOI:10.1007/BF03012602

PMID:10210047

Abstract

PURPOSE

To determine the plasma concentrations of propofol required to achieve different levels of sedation during monitored anesthesia care.

METHODS

Sixty ASA I-II, 18-65 yr-old patients, received a target-controlled continuous iv infusion of propofol. The target plasma concentration of propofol (Cpt) was initially set at 0.4 microg x ml(-1). Two minutes after calculated equilibrium between plasma and effect-site concentrations, the Cpt of propofol was increased by 0.2 microg x ml(-1) steps until the patient showed no reaction to squeezing the trapezius. The level of sedation was assessed immediately before each increase in propofol Cpt using the Observer's Assessment of Alertness/Sedation (OAA/S) scale.

RESULTS

The Cpt of propofol required to induce lethargic response to name was 1.3 microg x ml(-1) (5 degrees and 95 degrees percentiles: 1.0 - 1.8 microg x ml(-1)), to obtain response after loud and repeated calling name was 1.7 microg x ml(-1) (1.2 - 2.2 microg x ml(-1)), to obtain response after prodding or shaking was 2.0 microg x ml(-1) (1.6 - 2.6 microg x ml(-1)), to obtain response after squeezing the trapezius was 2.4 microg x ml(-1) (1.8 - 3.0 microg x ml(-1)). Patients showed no response after squeezing the trapezius at 2.8 microg x ml(-1) (2.0 - 3.6 microg x ml(-1)). Correlation between Cpt propofol and sedation scores were r = 0.76, P < 0.0001.

CONCLUSIONS

Target-controlled infusion of propofol provided easy and safe management of intraoperative sedation, allowing fast and predictable deepening in the level of sedation, while minimizing systemic side effects of intravenous sedation due to the minimal risk of overdosing the drug.

摘要

目的

确定在麻醉监测下达到不同镇静水平所需的丙泊酚血浆浓度。

方法

60例年龄在18 - 65岁的美国麻醉医师协会（ASA）I - II级患者接受丙泊酚靶控持续静脉输注。丙泊酚的目标血浆浓度（Cpt）最初设定为0.4μg·ml⁻¹。在计算得出血浆和效应室浓度达到平衡后两分钟，丙泊酚的Cpt以0.2μg·ml⁻¹的步长增加，直至患者对挤压斜方肌无反应。在每次增加丙泊酚Cpt之前，使用观察者警觉/镇静评估（OAA/S）量表立即评估镇静水平。

结果

引起对呼唤名字呈嗜睡反应所需的丙泊酚Cpt为1.3μg·ml⁻¹（第5和第95百分位数：1.0 - 1.8μg·ml⁻¹），大声反复呼唤名字后有反应所需的丙泊酚Cpt为1.7μg·ml⁻¹（1.2 - 2.2μg·ml⁻¹），轻推或摇晃后有反应所需的丙泊酚Cpt为2.0μg·ml⁻¹（1.6 - 2.6μg·ml⁻¹），挤压斜方肌后有反应所需的丙泊酚Cpt为2.4μg·ml⁻¹（1.8 - 3.0μg·ml⁻¹）。在丙泊酚Cpt为2.8μg·ml⁻¹（2.0 - 3.6μg·ml⁻¹）时，患者挤压斜方肌后无反应。丙泊酚Cpt与镇静评分之间的相关性为r = 0.76，P < 0.0001。