Schoneboom B A
AANA J. 1992 Jun;60(3):304-7.
This case report describes a general anesthetic where ketorolac tromethamine was used instead of a narcotic. The patient was a 37-year-old male, ASA II category, who underwent general anesthesia for a cholecystectomy. The drug is discussed in terms of preoperative, intraoperative, and immediate postoperative effects. During the preoperative phase, no effect was demonstrated. Intraoperatively, the drug performed poorly to attenuate responses to intense stimulation as noted by an increase in pulse and blood pressure of greater than 20% during intubation, incision, and abdominal wall retraction. During the immediate postoperative phase, the drug performed well to provide analgesia related to incisional pain. Ketorolac has not been previously discussed in terms of intraoperative uses. The mechanism of action by which it provides analgesia is through the inhibition of prostaglandin synthesis. It is similar in structure to the other nonsteroidal anti-inflammatory drugs and may offer certain advantages over traditional agents used to provide analgesia, including the absence of respiratory depression, addictive potential, euphoria, a decrease in gastric motility, and cardiovascular effects. These properties may help in the management of certain types of patients who are at risk for respiratory depression or in those who have a contraindication to narcotics.
本病例报告描述了一例使用酮咯酸氨丁三醇替代麻醉性镇痛药的全身麻醉情况。患者为一名37岁男性，美国麻醉医师协会（ASA）分级为Ⅱ级，因胆囊切除术接受全身麻醉。本文从术前、术中和术后即刻效果方面对该药物进行了讨论。在术前阶段，未显示出效果。术中，该药物在减轻对强烈刺激的反应方面表现不佳，如在插管、切开和腹壁牵拉期间脉搏和血压升高超过20%。在术后即刻阶段，该药物在缓解切口疼痛相关的镇痛方面表现良好。此前尚未对酮咯酸在术中的应用进行过讨论。其提供镇痛作用的作用机制是通过抑制前列腺素合成。它在结构上与其他非甾体类抗炎药相似，可能比用于提供镇痛的传统药物具有某些优势，包括无呼吸抑制、成瘾潜力、欣快感、胃动力降低和心血管影响。这些特性可能有助于管理某些有呼吸抑制风险的患者或对麻醉性镇痛药有禁忌证的患者。
