Sharrock N E, Go G, Mineo R
Department of Anesthesiology, Hospital for Special Surgery, New York, NY 10021.
Br J Anaesth. 1991 Dec;67(6):694-8. doi: 10.1093/bja/67.6.694.
Thirty patients undergoing primary total hip replacement under lumbar extradural anaesthesia with 0.75% bupivacaine 25 ml were allocated randomly to receive either low-dose adrenaline or phenylephrine infusions i.v. throughout surgery. Haemodynamic measurements and arterial blood samples were obtained before the extradural injection and at 10, 20, 30, 40, 50, 60 and 90 min thereafter. Peak arterial plasma concentrations of bupivacaine were observed 10 min after extradural anaesthesia and were significantly lower in patients receiving adrenaline infusions. Cardiac output was significantly greater in patients receiving adrenaline infusions (P less than 0.01). It is postulated that the smaller circulating concentrations of bupivacaine observed in patients receiving adrenaline were caused by increased cardiac output and a greater volume of distribution than in patients receiving phenylephrine.
30例接受腰段硬膜外麻醉下行初次全髋关节置换术的患者，使用25 ml 0.75%布比卡因，在整个手术过程中随机分配接受静脉输注低剂量肾上腺素或去氧肾上腺素。在硬膜外注射前以及注射后10、20、30、40、50、60和90分钟采集血流动力学测量值和动脉血样本。硬膜外麻醉后10分钟观察到布比卡因的动脉血浆峰值浓度，接受肾上腺素输注的患者该浓度显著较低。接受肾上腺素输注的患者心输出量显著更高（P小于0.01）。据推测，接受肾上腺素的患者体内布比卡因的循环浓度较低是由于心输出量增加以及与接受去氧肾上腺素的患者相比分布容积更大所致。
