Singh A, Mehta Y, Trehan N
Department of Cardiac Anaesthesia, Escorts Heart Institute and Research Centre, Okhla Road, New Delhi, India.
Ann Card Anaesth. 2000 Jan;3(1):11-8.
The haemodynamic effects of propofol -fentanyl anaesthesia (n=25) were compared with isoflurane-fentanyl anaesthesia (n=25) in patients with normal left ventricular ejection fraction (>45%) undergoing coronary artery bypass graft surgery under cardiopulmonary bypass. In the propofol group (Group P), anaesthesia was induced with midoazolam 2.5 to 5.0 mg, fentanyl 5mg/kg, pancuronium 0.1 mg/kg and propofol 1-2 mg/kg and was maintained with propofol infusion 10 mg/kg/hr till sternotomy, followed by 3 mg/kg/hr till skin closure. In the inhalational group (Group I) anaesthesia was induced with midazolam, fentanyl, pancuronium in the same doses and sleep dose of thiopentone and was maintained with oxygen : nitrous oxide (50:50) and isoflurane (0.5-1%). Additional fentanyl 2.5 microg/kg was given before sternotomy. Haemodynamic measurements were made before induction, after induction, after sternotomy, after heparinisation, after release of aortic cross clamp, post-bypass, post-sternal closure and on arrival in the recovery room. Post-bypass the cardiac index was higher in Group P (2.90+/- 0.76 v/s 2.40 +/- 0.40, p <0.05). Similarly post-bypass stroke volume index was higher in Group P (379.32 +/- 6.31 v/s 26.78 +/- 6.24, p<0.05). Patients in Group P were extubated earlier as compared to Group I (379.50 +/- 69 min v/s 453.00 +/- 134 min, p<0.05). This study suggests that propofol may be a suitable adjunct to opioid anaesthesia in patients with normal left ventricular ejection fraction undergoing coronary artery bypass graft surgery.
在体外循环下行冠状动脉搭桥手术的左心室射血分数正常（>45%）的患者中，比较了丙泊酚-芬太尼麻醉（n = 25）与异氟烷-芬太尼麻醉（n = 25）的血流动力学效应。在丙泊酚组（P组），麻醉诱导采用咪达唑仑2.5至5.0毫克、芬太尼5毫克/千克、泮库溴铵0.1毫克/千克和丙泊酚1 - 2毫克/千克，直至胸骨切开术期间以10毫克/千克/小时的速度输注丙泊酚维持麻醉，随后以3毫克/千克/小时的速度维持直至皮肤缝合。在吸入组（I组），麻醉诱导采用相同剂量的咪达唑仑、芬太尼、泮库溴铵和硫喷妥钠睡眠剂量，并以氧气：氧化亚氮（50:50）和异氟烷（0.5 - 1%）维持麻醉。在胸骨切开术前给予额外的芬太尼2.5微克/千克。在诱导前、诱导后、胸骨切开术后、肝素化后、主动脉交叉钳夹松开后、体外循环后、胸骨关闭后以及进入恢复室时进行血流动力学测量。体外循环后，P组的心指数较高（2.90±0.76对2.40±0.40，p<0.05）。同样，体外循环后P组的每搏量指数较高（379.32±6.31对26.78±6.24，p<0.05）。与I组相比，P组患者拔管更早（379.50±69分钟对453.00±134分钟，p<0.05）。这项研究表明，对于左心室射血分数正常且行冠状动脉搭桥手术的患者，丙泊酚可能是阿片类麻醉的合适辅助药物。
