Hickey P R, Hansen D D
Department of Anesthesia, Children's Hospital, Boston, MA 02115.
J Clin Anesth. 1991 Jul-Aug;3(4):295-300. doi: 10.1016/0952-8180(91)90223-a.
To determine retrospectively the effect of high-dose opiate-oxygen (O2) anesthetic technique on intraoperative ventricular fibrillation in high-risk neonates.
Retrospective chart review of different anesthetic techniques in a partially contemporaneous patient group (1981 to 1983).
Cardiac anesthesia service at a university pediatric hospital.
Forty neonates undergoing Norwood Stage I repair of hypoplastic left heart syndrome.
High-dose fentanyl-O2 anesthesia in 30 neonates and low-dose morphine sulfate 50%-nitrous oxide (N2O) in 10 neonates.
Clinical condition assessed by preoperative and intraoperative arterial blood gases, requirements for sodium bicarbonate (NaHCO3), need for inotropic and pressor support, and vital signs. Outcome assessments by intraoperative ventricular fibrillation (frequency before and after bypass) and hospital mortality. Clinical condition and hospital mortality were no different. The frequency of intraoperative ventricular fibrillation was significantly different: 3% with high-dose fentanyl and 50% with morphine-N2O (p less than 0.005).
High-dose opiate-O2 anesthesia in these patients markedly decreased intraoperative ventricular fibrillation. Other clinical reports and recent experimental work suggest that this finding is due to high-dose opiates rather than the avoidance of N2O.
回顾性确定高剂量阿片 - 氧气（O₂）麻醉技术对高危新生儿术中室颤的影响。
对部分同期患者组（1981年至1983年）不同麻醉技术进行回顾性病历审查。
一所大学儿科医院的心脏麻醉科。
40例接受诺伍德一期左心发育不全综合征修复术的新生儿。
30例新生儿采用高剂量芬太尼 - O₂麻醉，10例新生儿采用低剂量硫酸吗啡 - 50%氧化亚氮（N₂O）麻醉。
通过术前和术中动脉血气、碳酸氢钠（NaHCO₃）需求、对正性肌力药和升压药支持的需求以及生命体征评估临床状况。通过术中室颤（体外循环前后的发生率）和医院死亡率进行结局评估。临床状况和医院死亡率无差异。术中室颤发生率有显著差异：高剂量芬太尼组为3%，吗啡 - N₂O组为50%（p < 0.005）。
这些患者采用高剂量阿片 - O₂麻醉可显著降低术中室颤。其他临床报告和近期实验研究表明，这一发现归因于高剂量阿片类药物，而非避免使用N₂O。
