Tabuchi Y
Division of Anesthesia, Nagahama City Hospital, Nagahama 526-8580.
Masui. 2001 Jan;50(1):29-33.
A retrospective study was performed to determine the influence of age on hemodynamics and awakening time in total intravenous anesthesia (TIVA) with propofol and buprenorphine for spinal surgery. Twenty patients (26-79 yr) were studied and allocated into following four groups by age: 26-49 yr, 50-59 yr, 60-69 yr, and elderly 70-79 yr. All patients were premedicated with midazolam (2.5-5 mg) i.m. Anesthesia was induced (60-180 ml.h-1) and maintained (20-60 ml.h-1) with propofol infusion with 40% oxygen in air, added with vecuronium and one single dose of buprenorphine (0.08-0.2 mg; 1.37-2.63 micrograms.kg-1) before incision. Mean arterial pressure was stable and did not differ in four groups. Heart rate was decreased (P < 0.01) in the elderly group compared with the group younger than 50 yr. Bradycardia (below 50 beat.min-1) occurred in 60% of the elderly group. An adequate dose of buprenorphine (microgram) was proposed as: 208 - 1.8 x age (yr) + 0.3 x weight (kg) (r = 0.90, P < 0.01). The induction and maintenance rates (ml.h-1) of propofol were decreased with age and increased with weight (P < 0.05). However, the maintenance dose of propofol (3.9-8.5 mg.kg-1.h-1) did not correlate with age. Awakening time was prolonged (P < 0.05) in the elderly group (17.0 +/- 7.2 min) as compared with the group of younger than 50 yr (8.0 +/- 3.9 min). The three patients requiring postoperative analgesics were younger than 60 yr. This study suggests that we should reduce the dose of buprenorphine with age in TIVA using propofol. About 50% of the dose given to the patient younger than 50 yr was considered adequate in the elderly group.
进行了一项回顾性研究，以确定年龄对丙泊酚和丁丙诺啡用于脊柱手术的全静脉麻醉（TIVA）中血流动力学和苏醒时间的影响。研究了20例患者（26 - 79岁），并按年龄分为以下四组：26 - 49岁、50 - 59岁、60 - 69岁和老年组70 - 79岁。所有患者均肌内注射咪达唑仑（2.5 - 5mg）进行术前用药。采用丙泊酚输注诱导麻醉（60 - 180ml·h⁻¹）并维持麻醉（20 - 60ml·h⁻¹），吸入含40%氧气的空气，术前加用维库溴铵和单次剂量的丁丙诺啡（0.08 - 0.2mg；1.37 - 2.63μg·kg⁻¹）。四组患者的平均动脉压稳定且无差异。与年龄小于50岁的组相比，老年组心率降低（P < 0.01）。老年组60%的患者出现心动过缓（低于50次·min⁻¹）。建议丁丙诺啡的合适剂量（μg）为：208 - 1.8×年龄（岁） + 0.3×体重（kg）（r = 0.90，P < 0.01）。丙泊酚的诱导和维持速率（ml·h⁻¹）随年龄降低而降低，随体重增加而增加（P < 0.05）。然而，丙泊酚的维持剂量（3.9 - 8.5mg·kg⁻¹·h⁻¹）与年龄无关。与年龄小于50岁的组（8.0 ± 3.9min）相比，老年组（17.0 ± 7.2min）的苏醒时间延长（P < 0.05）。三名需要术后镇痛的患者年龄小于60岁。本研究表明，在使用丙泊酚的TIVA中，应随年龄降低丁丙诺啡的剂量。老年组的剂量约为年龄小于50岁患者剂量的50%时被认为是合适的。
