Rieschke Petra, LaFleur Bonnie J, Janicki Piotr K
Department of Anesthesiology, Division of Biostatistics, Nashville, TN 37232, USA.
Anesthesiology. 2003 Feb;98(2):323-8. doi: 10.1097/00000542-200302000-00009.
The formulation of sulfite-containing propofol (SCP) has not been thoroughly investigated in patients with the extensive smoking history for the effects on the total respiratory system resistance after tracheal intubation. However adverse effects, including acute asthma and bronchospasm, have been reported with several other parenteral formulations of drugs containing sulfite as preservative. Therefore, the aim of this prospective randomized and double blind study was to investigate the effects of EDTA-containing propofol (ECP) and SCP on total respiratory system resistance (Rrs) in patients with the prolonged smoking history and undergoing propofol-based total intravenous anesthesia with tracheal intubation.
40 patients scheduled for general anesthesia were enrolled into the study. Anesthesia was induced with either 2 mg/kg ECP, or 2 mg/kg SCP followed by vecuronium (0.1 mg/kg) to ensure complete neuromuscular relaxation for the time of the study. Maintenance anesthesia was continued with propofol infusion at 0.15 mg/kg/min for the first 15 min after intubation. Total respiratory system resistance (Rrs), was measured continuously for 10 min postintubation.
The analysis of repeated Rrs measurements taken every minute for 10 min postintubation revealed trend consisting of higher Rrs in the SCP group when compared to the ECP group. The statistical analysis of the data performed using repeated measures analysis of covariance demonstrated statistically significant effect (P < 0.05) of the treatment group factor (SCP vs. ECP) and the time factor (time after intubation) on the postintubation Rrs.
The total respiratory system resistance measured repeatedly for 10 min after tracheal intubation in patients with smoking history is significantly elevated after induction with SCP than after induction with ECP. The preservative used for propofol formulation may alter the effects of propofol on the total respiratory system resistance in smokers.
对于有广泛吸烟史的患者，含亚硫酸盐丙泊酚（SCP）制剂在气管插管后对总呼吸系统阻力的影响尚未进行全面研究。然而，已有报道称，其他几种含有亚硫酸盐作为防腐剂的胃肠外给药制剂会产生包括急性哮喘和支气管痉挛在内的不良反应。因此，这项前瞻性随机双盲研究的目的是调查含乙二胺四乙酸丙泊酚（ECP）和SCP对有长期吸烟史且接受基于丙泊酚的全凭静脉麻醉并气管插管患者的总呼吸系统阻力（Rrs）的影响。
40例计划接受全身麻醉的患者纳入本研究。使用2mg/kg ECP或2mg/kg SCP诱导麻醉，随后给予维库溴铵（0.1mg/kg），以确保在研究期间完全神经肌肉松弛。插管后最初15分钟内，以0.15mg/kg/分钟的速度持续输注丙泊酚维持麻醉。插管后连续10分钟测量总呼吸系统阻力（Rrs）。
对插管后10分钟内每分钟重复测量的Rrs进行分析发现，与ECP组相比，SCP组的Rrs有升高趋势。使用重复测量协方差分析对数据进行的统计分析表明，治疗组因素（SCP与ECP）和时间因素（插管后时间）对插管后Rrs有统计学显著影响（P<0.05）。
有吸烟史的患者在气管插管后10分钟内重复测量的总呼吸系统阻力，在使用SCP诱导后比使用ECP诱导后显著升高。用于丙泊酚制剂的防腐剂可能会改变丙泊酚对吸烟者总呼吸系统阻力的影响。
