Nishiyama Tomoki
Department of Anesthesiology, The University of Tokyo, Faculty of Medicine, 7-3-1, Hongo, Tokyo 113-8655, Japan.
J Anesth. 2007;21(2):265-9. doi: 10.1007/s00540-006-0489-3. Epub 2007 May 30.
The dose and time course of propofol infusion required to induce rapid sedation without oversedation during spinal anesthesia were investigated.
Forty patients scheduled for spinal and epidural anesthesia were studied. After premedication with intramuscular midazolam 0.04 mg.kg(-1), an epidural catheter was inserted, followed by spinal anersthesia at L4-L5 with 0.5% hyperbaric tetracaine with epinephrine. The infusion of propofol was started with 10 mg.kg(-1).h(-1) and was decreased to 5 mg.kg(-1).h(-1) at spontaneous eye closure. According to the increase or decrease of the sedation level, the infusion does was decreased or increased to half or twice the initial dose, respectively, to keep the Observer's Assessment of Alertness Sedation (OAAS) score at 3 or 4.
Eye closure was observed at 1.0 +/- 0.4 min after the start of insusion. The maintenance insusion dose to keep the OAAS score at 3 or 4 was about 2.5 mg.kg(-1).h(-1).
Propofol infusion, starting with 10 mg.kg(-1).h(-1), decreasing to 5 mg.kg(-1).h(-1) after 1 minute, and then decreasing to 2.5 mg.kg(-1).h(-1) after another min induced rapid onset of sedation and kept the OAAS score at 3 or 4 during spinal anesthesia.
研究在脊髓麻醉期间诱导快速镇静且不过度镇静所需的丙泊酚输注剂量和时间过程。
对40例计划行脊髓和硬膜外麻醉的患者进行研究。肌内注射咪达唑仑0.04 mg·kg⁻¹进行术前用药后，插入硬膜外导管，然后于L4-L5间隙用含肾上腺素的0.5%重比重丁卡因行脊髓麻醉。丙泊酚以10 mg·kg⁻¹·h⁻¹的速度开始输注，在患者自主闭眼时减至5 mg·kg⁻¹·h⁻¹。根据镇静水平的升高或降低，输注剂量分别减至初始剂量的一半或增至初始剂量的两倍，以使观察者警觉/镇静评分（OAAS）维持在3或4分。
输注开始后1.0±0.4分钟观察到患者闭眼。维持OAAS评分在3或4分的输注维持剂量约为2.5 mg·kg⁻¹·h⁻¹。
丙泊酚输注，起始速度为10 mg·kg⁻¹·h⁻¹，1分钟后减至5 mg·kg⁻¹·h⁻¹，再过一分钟后减至2.5 mg·kg⁻¹·h⁻¹，可在脊髓麻醉期间迅速诱导镇静，并使OAAS评分维持在3或4分。
