Orme Ruari, Leslie Kate, Umranikar Abhay, Ugoni Antony
Department of Anaesthesia, Ballarat Base Hospital, Ballarat, Victoria, Australia.
Anesth Analg. 2002 Jan;94(1):112-6, table of contents. doi: 10.1097/00000539-200201000-00021.
The administration of esmolol decreases the propofol blood concentration, preventing movement after skin incision during propofol/morphine/nitrous oxide anesthesia. However, interaction with esmolol has not been tested when propofol is infused alone. Accordingly, we tested the hypothesis that esmolol decreases the propofol blood concentration, preventing response to command (CP50-awake) when propofol is infused alone in healthy patients presenting for minor surgery. With approval and consent, we studied 30 healthy patients, who were randomized to esmolol bolus (1 mg/kg) and then infusion (250 microg x kg(-1) x min(-1)) or placebo. Five minutes later, a target-controlled infusion of propofol was commenced. Ten minutes later, responsiveness was assessed by a blinded observer. Oxygen saturation, heart rate, and noninvasive arterial blood pressure were recorded every 2 min. Arterial blood samples were taken at 5 and 10 min of propofol infusion for propofol assay. Results were analyzed with a generalized linear regression model: P <0.05 was considered statistically significant. The probability of response to command decreased with increasing propofol blood concentration (CP50-awake = 3.42 microg/mL). Esmolol did not alter the relative risk of response to command. We conclude that the previously observed effect of esmolol on propofol CP50 was not caused by an interaction between these two drugs.
There is no evidence to suggest that esmolol, an ultra-short-acting cardioselective beta-blocker, affects anesthetic requirement for loss of responsiveness during propofol anesthesia.
艾司洛尔的使用可降低丙泊酚血药浓度，在丙泊酚/吗啡/氧化亚氮麻醉期间防止皮肤切开后出现体动。然而，单独输注丙泊酚时，尚未测试其与艾司洛尔的相互作用。因此，我们检验了以下假设：在接受小型手术的健康患者中，单独输注丙泊酚时，艾司洛尔可降低丙泊酚血药浓度，防止对指令的反应（清醒状态下的半数有效浓度[CP50-awake]）。经批准并获得同意后，我们研究了30例健康患者，将其随机分为艾司洛尔推注组（1 mg/kg），随后持续输注组（250 μg·kg⁻¹·min⁻¹）或安慰剂组。5分钟后，开始靶控输注丙泊酚。10分钟后，由一名不知情的观察者评估反应性。每2分钟记录一次血氧饱和度、心率和无创动脉血压。在丙泊酚输注5分钟和10分钟时采集动脉血样本进行丙泊酚测定。结果采用广义线性回归模型进行分析：P<0.05被认为具有统计学意义。对指令的反应概率随丙泊酚血药浓度升高而降低（清醒状态下的半数有效浓度[CP50-awake]=3.42 μg/mL）。艾司洛尔未改变对指令反应的相对风险。我们得出结论，先前观察到的艾司洛尔对丙泊酚CP50的影响并非由这两种药物之间的相互作用所致。
没有证据表明超短效心脏选择性β受体阻滞剂艾司洛尔会影响丙泊酚麻醉期间意识消失的麻醉需求。
