Fukayama H, Kohase H, Umino M
Department of Anesthesiology, Graduate School, Tokyo Medical and Dental University, Japan.
Can J Anaesth. 2000 Nov;47(11):1141-3. doi: 10.1007/BF03027969.
Propofol is widely used for general anesthesia because of its rapid onset and recovery. We had four cases that had higher body temperatures toward the end of anesthesia. The etiology of the hyperthermia is discussed.
Four patients (three male, one female, 22-26 yr of age, weighing 53-57 kg) with facial deformities were anesthetized with propofol infusion (3-10 mg x kg(-1) x hr(-1)) and fentanyl (400-1,300 microg) without nitrous oxide, immobilized with vecuronium bromide (18-37 mg) or pancuronium bromide (31 mg). In order to reduce blood loss and improve the surgical view, tri-nitro-glycerin (TNG) was used in all cases. Osteotomy of maxilla and mandible or sagittal split ramus osteotomy of mandible was successfully performed. Although their body temperatures were normal preoperatively and stable during the operation, toward the end of anesthesia (one hour), they increased to over 38 degrees C. The room temperature was decreased and the water blanket on the operating table was also decreased. In addition, cool crystalloid solution was infused. Body temperature returned to normal in the ward and no complications due to the high temperature were seen postoperatively. It is thought that lighter anesthesia was masked by continuous infusion of propofol and TNG-induced hypotension and that benign hyperthermia occurred toward the end of anesthesia.
Propofol reduces blood pressure, which suggests deep anesthesia. However, care must be taken to maintain the optimum depth of anesthesia during propofol anesthesia, especially when deliberate hypotensive anesthesia is induced.
丙泊酚因其起效迅速且苏醒快而被广泛用于全身麻醉。我们有4例患者在麻醉即将结束时体温升高。本文对这种体温过高的病因进行了讨论。
4例面部畸形患者（3例男性，1例女性，年龄22 - 26岁，体重53 - 57千克），采用丙泊酚输注（3 - 10毫克·千克⁻¹·小时⁻¹）和芬太尼（400 - 1300微克）进行麻醉，未使用氧化亚氮，并用维库溴铵（18 - 37毫克）或泮库溴铵（31毫克）进行肌松。为减少失血并改善手术视野，所有病例均使用了三硝酸甘油（TNG）。成功实施了上颌骨和下颌骨截骨术或下颌骨矢状劈开截骨术。尽管患者术前体温正常且术中稳定，但在麻醉即将结束时（1小时），体温升至38摄氏度以上。降低了室温，手术台上的水毯温度也降低了。此外，输注了冷晶体溶液。患者在病房体温恢复正常，术后未出现因高温导致的并发症。据认为，丙泊酚持续输注和TNG引起的低血压掩盖了较浅的麻醉状态，导致在麻醉即将结束时出现良性体温过高。
丙泊酚会降低血压，这提示麻醉较深。然而，在丙泊酚麻醉期间，尤其是在实施控制性低血压麻醉时，必须注意维持最佳麻醉深度。
