Smith I, Van Hemelrijck J, White P F
Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri 63110.
Anesth Analg. 1991 Nov;73(5):540-6.
In 97 outpatients undergoing ambulatory arthroscopic procedures, we compared esmolol with alfentanil when used to supplement propofol-N2O-atracurium anesthesia according to a randomized, double-blind protocol. After an initial intravenous dose of 16 micrograms/kg alfentanil, or 2 mg/kg of esmolol, a variable-rate infusion of alfentanil or esmolol was administered to maintain a stable heart rate. After induction of anesthesia with 2.5 mg/kg of propofol, mean arterial pressure decreased to a larger extent in the alfentanil-treated patients. Although heart rate and mean arterial pressure increased in both groups after tracheal intubation, alfentanil more effectively blunted the hemodynamic response to this stimulus. Maintenance of anesthesia was adequate in both treatment groups. After discontinuation of anesthesia, patients in the esmolol group opened their eyes earlier (7.2 +/- 2.4 min vs 9.8 +/- 4.6 min) than those in the alfentanil group. Esmolol-treated patients also reported less sedation in the first 15 min of recovery than those receiving alfentanil. However, there were no differences in times to ambulation and discharge between the groups. Esmolol-treated patients reported more postoperative pain for the first 15 min of recovery and more esmolol-treated patients required postoperative opioid analgesia than those treated with alfentanil. There were no significant differences in the incidences of nausea and vomiting between the two groups. The authors conclude that esmolol may be used in place of alfentanil to supplement propofol-N2O-atracurium anesthesia in outpatients undergoing arthroscopic procedures. However, hemodynamic responses to tracheal intubation were larger with esmolol, and avoidance of alfentanil did not decrease the incidence of postoperative nausea and vomiting in this outpatient population.
在97例接受门诊关节镜手术的患者中，我们按照随机、双盲方案，比较了艾司洛尔与阿芬太尼用于补充丙泊酚-氧化亚氮-阿曲库铵麻醉时的效果。在初始静脉注射16微克/千克阿芬太尼或2毫克/千克艾司洛尔后，以可变速率输注阿芬太尼或艾司洛尔以维持稳定心率。在用2.5毫克/千克丙泊酚诱导麻醉后，阿芬太尼治疗组患者的平均动脉压下降幅度更大。虽然两组在气管插管后心率和平均动脉压均升高，但阿芬太尼更有效地减弱了对该刺激的血流动力学反应。两个治疗组的麻醉维持均充分。麻醉停止后，艾司洛尔组患者比阿芬太尼组患者睁眼更早（7.2±2.4分钟对9.8±4.6分钟）。在恢复的前15分钟，艾司洛尔治疗的患者比接受阿芬太尼的患者报告的镇静程度更低。然而，两组之间在行走和出院时间上没有差异。在恢复的前15分钟，艾司洛尔治疗的患者报告的术后疼痛更多，并且与阿芬太尼治疗的患者相比，更多接受艾司洛尔治疗的患者需要术后使用阿片类镇痛药。两组之间恶心和呕吐的发生率没有显著差异。作者得出结论，在接受关节镜手术的门诊患者中，艾司洛尔可用于替代阿芬太尼补充丙泊酚-氧化亚氮-阿曲库铵麻醉。然而，艾司洛尔对气管插管的血流动力学反应更大，并且避免使用阿芬太尼并未降低该门诊患者群体的术后恶心和呕吐发生率。
