Marx W, Shah N, Long C, Arbit E, Galicich J, Mascott C, Mallya K, Bedford R
Cornell University Medical College and The Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
J Neurosurg Anesthesiol. 1989 Mar;1(1):3-7.
In order to evaluate the safety of the new synthetic opioids, alfentanil and sufentanil, in neurosurgical patients, we administered sufentanil 1 microg/kg i.v., alfentanil 50 microg/kg i.v. followed by an infusion of 1 microg/kg/min, or fentanyl 5 microg/kg i.v. to 30 patients with supratentorial tumors anesthetized with nitrous oxide (N2O), 60% in O2. Lumbar cerebrospinal fluid pressure (CSFP) and mean arterial pressure (MAP) responses were recorded for 10 min thereafter, while ventilation was held constant [mean PaCO2 = 36.1 +/- 1.0 mm Hg (SEM)]. There was no change in CSFP after fentanyl. In contrast, both sufentanil and alfentanil caused increases in CSFP, equal to 89 +/- 31 % SE (p < 0.05) and 22 +/- 5% (p < 0.05), respectively. MAP decreased after administration of each opioid. Peak decreases in cerebral perfusion pressure (MAP - CSFP) were 14 +/- 3% after fentanyl, 25 +/- 5% after sufentanil, and 37 +/- 3% after alfentanil. It is concluded that because sufentanil increased CSFP in patients who have brain tumors, it also may be contraindicated in other neurosurgical patients at risk for intracranial hypertension. Alfentanil may share this propensity, since CSFP increased despite a profound reduction in MAP. Among the three opioids evaluated, only fentanyl appears to be appropriate for supplementing N2O-2 anesthesia in patients who have compromised intracranial compliance.
为评估新型合成阿片类药物阿芬太尼和舒芬太尼在神经外科手术患者中的安全性，我们对30例幕上肿瘤患者静脉注射舒芬太尼1微克/千克、阿芬太尼50微克/千克，随后以1微克/千克/分钟的速度输注，或静脉注射芬太尼5微克/千克，这些患者采用60%氧气和氧化亚氮（N2O）麻醉。此后记录10分钟的腰脑脊液压力（CSFP）和平均动脉压（MAP）反应，同时保持通气恒定[平均动脉血二氧化碳分压=36.1±1.0毫米汞柱（标准误）]。芬太尼注射后CSFP无变化。相比之下，舒芬太尼和阿芬太尼均导致CSFP升高，分别相当于89±31%标准误（p<0.05）和22±5%（p<0.05）。每种阿片类药物注射后MAP均下降。芬太尼注射后脑灌注压（MAP - CSFP）的最大降幅为14±3%，舒芬太尼为25±5%，阿芬太尼为37±3%。得出结论，由于舒芬太尼可使脑肿瘤患者的CSFP升高，因此在有颅内高压风险的其他神经外科手术患者中也可能禁忌使用。阿芬太尼可能也有这种倾向，因为尽管MAP大幅下降，但CSFP仍升高。在评估的三种阿片类药物中，只有芬太尼似乎适合用于补充颅内顺应性受损患者的N2O-氧气麻醉。
