Contreras Domínguez V, Carbonell Bellolio P, Ojeda Greciet A, Sanzana E S
Servicio de Anestesiología, Hospital Clínico Regional de Concepción, Chile.
Rev Esp Anestesiol Reanim. 2007 Aug-Sep;54(7):421-4.
To assess the effects of 2 dosages of intrathecal fentanyl on the requirement for propofol infused intravenously for the sedation of patients under spinal anesthesia.
We conducted a prospective controlled clinical trial enrolling patients in ASA physical status class 1 randomly assigned to 3 groups. Group 1 received 12.5 mg of 0.75% hyperbaric bupivacaine; group 2, 12.5 mg of bupivacaine plus 15 microg of fentanyl; group 3, 12.5 mg of bupivacaine plus 25 microg of fentanyl. After initiation of spinal anesthesia, monitoring of the bispectral (BIS) index (BIS XP A-2000) was begun, and sedation was maintained with a propofol infusion through a target-controlled infusion device (Orchestra Base Primea) for an initial effect-site concentration of 2.5 microg mL(-1), which was adjusted to maintain the BIS index between 60 and 75. We recorded BIS indices, noninvasive blood pressure, electrocardiogram, oxygen saturation, nasal end-tidal carbon dioxide pressure, mean infusion dose of propofol, total infusion dose of propofol, time until awakening, propofol consumption, and adverse effects.
Seventy-five patients (25 in each group) were enrolled. Patient characteristics and BIS indices were similar in all groups. Propofol doses were significantly lower and times until awakening were significantly shorter in groups 2 and 3 than in group 1 (P < .01). The incidences of pruritus were significantly higher in groups 2 and 3.
Adding 15 or 25 microg of fentanyl to hyperbaric bupivacaine lowers the dose of intravenous propofol required for sedation of patients under spinal anesthesia.
评估两种剂量的鞘内注射芬太尼对脊髓麻醉患者静脉输注丙泊酚镇静所需剂量的影响。
我们进行了一项前瞻性对照临床试验，将美国麻醉医师协会（ASA）身体状况分级为1级的患者随机分为3组。第1组接受12.5mg的0.75%高压布比卡因；第2组，12.5mg布比卡因加15μg芬太尼；第3组，12.5mg布比卡因加25μg芬太尼。脊髓麻醉开始后，开始监测脑电双频指数（BIS）（BIS XP A - 2000），并通过靶控输注装置（Orchestra Base Primea）输注丙泊酚以维持镇静，初始效应室浓度为2.5μg/mL（-1），并进行调整以维持BIS指数在60至75之间。我们记录了BIS指数、无创血压、心电图、血氧饱和度、鼻端潮气末二氧化碳分压、丙泊酚平均输注剂量、丙泊酚总输注剂量、苏醒时间、丙泊酚消耗量及不良反应。
共纳入75例患者（每组25例）。所有组的患者特征和BIS指数相似。第2组和第3组的丙泊酚剂量显著低于第1组，苏醒时间显著短于第1组（P < 0.01）。第2组和第3组瘙痒的发生率显著更高。
在高压布比卡因中添加15或25μg芬太尼可降低脊髓麻醉患者镇静所需的静脉丙泊酚剂量。
