氟烷、异氟烷和芬太尼会提高植入式心脏复律除颤器的最小有效除颤阈值：首例人体报告。

Halothane, isoflurane, and fentanyl increase the minimally effective defibrillation threshold of an implantable cardioverter defibrillator: first report in humans.

作者信息

Weinbroum Avi A, Glick Aharon, Copperman Yitzchak, Yashar Tamar, Rudick Valery, Flaishon Ron

机构信息

Post-Anesthesia Care Unit, Department of Anesthesiology and Critical Care, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel.

出版信息

Anesth Analg. 2002 Nov;95(5):1147-53, table of contents. doi: 10.1097/00000539-200211000-00004.

DOI:10.1097/00000539-200211000-00004

PMID:12401582

Abstract

UNLABELLED

Placing an implantable cardioverter defibrillator (ICD) involves the induction of ventricular fibrillation, whereupon the minimally effective defibrillation energy threshold (DFT) is determined. We evaluated the effects of 0.7% halothane, 1% isoflurane, or 1.5 micro g/kg of IV fentanyl during N(2)O/oxygen-based general anesthesia (GA) or those of subcutaneous 1.5% lidocaine plus IV 0.35 mg/kg of propofol on the DFT during ICD implantation in humans (n = 20 per group). Thirty minutes after the first set of DFT measurements under such conditions, the inhaled anesthetics were withdrawn, and all three GA groups received fentanyl 1 microg/kg IV (second set). A third set was taken 30 min later, before the GA patients awakened and when only N(2)O/oxygen was delivered for GA. The lidocaine plus propofol patients were given the same IV propofol bolus 1 min before each fibrillation/defibrillation trial and at the same time points as the three GA groups. The first DFTs were 16.1 +/- 2.2 J (halothane), 17.7 +/- 2.7 J (isoflurane), 16.4 +/- 2.9 J (fentanyl), and 12.9 +/- 3.8 J (lidocaine plus propofol) (P = 0.01). The second set of DFTs were significantly lower than the first sets for the halothane (P = 0.01) and isoflurane (P = 0.02), but not the fentanyl or lidocaine plus propofol, regimens. The third DFTs were significantly (P < 0.01) lower than the first ones for the three GA groups, but not for the lidocaine plus propofol patients. Thus, halothane, isoflurane, and fentanyl increased DFT values during ICD implantation in humans, whereas lidocaine plus intermittent small-dose IV propofol minimized these thresholds.

IMPLICATIONS

Halothane, isoflurane, and IV fentanyl added to N(2)O/oxygen-based general anesthesia similarly increase minimal defibrillation threshold energy requirements (DFT) during cardioverter defibrillator implantation in humans. Subcutaneous lidocaine plus intermittent small-dose IV propofol minimizes DFT compared with these general anesthetics while providing equal patient satisfaction.

摘要

未标记

植入植入式心脏复律除颤器（ICD）时需要诱发心室颤动，随后确定最低有效除颤能量阈值（DFT）。我们评估了在基于氧化亚氮/氧气的全身麻醉（GA）期间，0.7% 氟烷、1% 异氟烷或 1.5 μg/kg 静脉注射芬太尼，或皮下注射 1.5% 利多卡因加静脉注射 0.35 mg/kg 丙泊酚对人类 ICD 植入期间 DFT 的影响（每组 n = 20）。在这些条件下进行第一组 DFT 测量 30 分钟后，停用吸入麻醉剂，所有三个 GA 组均接受 1 μg/kg 静脉注射芬太尼（第二组）。30 分钟后进行第三组测量，此时 GA 患者尚未苏醒，且仅给予氧化亚氮/氧气进行 GA。在每次颤动/除颤试验前 1 分钟以及与三个 GA 组相同的时间点，给利多卡因加丙泊酚组患者静脉注射相同剂量的丙泊酚。第一组 DFT 分别为 16.1±2.2 J（氟烷）、17.7±2.7 J（异氟烷）、16.4±2.9 J（芬太尼）和 12.9±3.8 J（利多卡因加丙泊酚）（P = 0.01）。第二组 DFT 对于氟烷（P = 0.01）和异氟烷（P = 0.02）显著低于第一组，但对于芬太尼组或利多卡因加丙泊酚组则不然。第三组 DFT 对于三个 GA 组显著（P < 0.01）低于第一组，但对于利多卡因加丙泊酚组患者则不然。因此，在人类 ICD 植入期间，氟烷、异氟烷和芬太尼会增加 DFT 值，而利多卡因加间歇性小剂量静脉注射丙泊酚可使这些阈值降至最低。