Habib A S, Parker J L, Maguire A M, Rowbotham D J, Thompson J P
University Department of Anaesthesia, Critical Care and Pain Management, University Hospitals of Leicester, Leicester Royal Infirmary, UK.
Br J Anaesth. 2002 Mar;88(3):430-3. doi: 10.1093/bja/88.3.430.
We compared the effects of remifentanil and alfentanil on arterial pressure and heart rate at induction of anaesthesia and tracheal intubation in 40 ASA I-III patients aged greater than 65 yr, in a randomized double-blind study.
Patients received either remifentanil 0.5 microg kg(-1) over 30 s, followed by an infusion of 0.1 microg kg min(-1) (group R) or alfentanil 10 microg kg(-1) over 30 s, followed by an infusion of saline (group A). Anaesthesia was then induced with propofol, rocuronium, and 1% isoflurane with 66% nitrous oxide in oxygen.
Systolic arterial pressure (SAP) and mean arterial pressure (MAP) decreased after the induction of anaesthesia (P<0.05) and increased for 3 min after intubation in both groups (P<0.05), but remained below baseline values throughout. Heart rate remained stable after induction of anaesthesia but increased significantly from baseline after intubation for 1 and 4 min in groups R and A, respectively (P<0.05). There were no significant between-group differences in SAP, MAP, and heart rate. Diastolic pressure was significantly higher in group A than group R at 4 and 5 min after intubation (P<0.05). Hypotension (SAP < 100 mm Hg) occurred in four patients in group R and three patients in group A.
Remifentanil and alfentanil similarly attenuate the pressor response to laryngoscopy and intubation, but the incidence of hypotension confirms that both drugs should be used with caution in elderly patients.
在一项随机双盲研究中，我们比较了瑞芬太尼和阿芬太尼对40例年龄大于65岁的美国麻醉医师协会（ASA）I-III级患者麻醉诱导和气管插管时动脉压及心率的影响。
患者在30秒内接受0.5微克/千克的瑞芬太尼，随后以0.1微克/千克·分钟的速度输注（R组），或在30秒内接受10微克/千克的阿芬太尼，随后输注生理盐水（A组）。然后用丙泊酚、罗库溴铵和1%异氟烷与66%氧化亚氮和氧气诱导麻醉。
两组患者麻醉诱导后收缩压（SAP）和平均动脉压（MAP）均下降（P<0.05），插管后3分钟内升高（P<0.05），但始终低于基线值。麻醉诱导后心率保持稳定，但R组和A组插管后1分钟和4分钟时心率分别较基线显著升高（P<0.05）。SAP、MAP和心率在组间无显著差异。插管后4分钟和5分钟时，A组舒张压显著高于R组（P<0.05）。R组有4例患者、A组有3例患者发生低血压（SAP<100毫米汞柱）。
瑞芬太尼和阿芬太尼对喉镜检查和插管时的升压反应有相似的减弱作用，但低血压的发生率表明这两种药物在老年患者中均应谨慎使用。
