Van Hemelrijck J, Van Aken H, Merckx L, Mulier J
Department of Anesthesiology, Katholieke Universiteit Leuven, Belgium.
J Clin Anesth. 1991 Mar-Apr;3(2):131-6. doi: 10.1016/0952-8180(91)90010-k.
To compare a total intravenous (IV) anesthetic technique based on propofol and alfentanil with a commonly used anesthetic technique for craniotomy.
Open-label, randomized, clinical study.
Neurosurgical clinic at a university hospital.
Forty patients, aged 18 to 55 years, scheduled for brain tumor surgery.
In 20 patients, anesthesia was induced with fentanyl and thiopental sodium and maintained with fentanyl, dehydrobenzperidol, isoflurane, nitrous oxide (N2O), and a thiopental sodium infusion. Twenty patients were anesthetized with a propofol loading infusion followed by a maintenance infusion at a fixed rate. In addition, alfentanil was administered as a loading bolus, followed by a variable-rate infusion, with additional doses as necessary to maintain hemodynamic stability.
A decrease in blood pressure (BP) after induction with thiopental sodium was followed by a significant increase in BP and heart rate (HR) during intubation. BP and HR did not change during the propofol loading infusion. However, the administration of alfentanil was followed by a similar decrease in BP with a return to baseline values during the intubation period. Return of normal orientation (7 +/- 5 minutes vs 27 +/- 23 minutes) and concentration (12 +/- 12 minutes vs 35 +/- 37 minutes) was shorter and more predictable for the propofol-alfentanil-treated patients than for the thiopental sodium patients. Maintenance propofol concentration (nine patients) was between 3 +/- 0.69 micrograms/ml and 3.36 +/- 1.17 micrograms/ml, while the concentration at awakening was 1.09 microgram/ml. Alfentanil concentration at extubation (nine patients) was 79 +/- 34 ng/ml.
A total IV anesthetic technique with propofol and alfentanil is a valuable alternative to a more commonly used technique based on thiopental sodium, N2O, fentanyl, and isoflurane.
比较基于丙泊酚和阿芬太尼的全静脉麻醉技术与常用的开颅手术麻醉技术。
开放标签、随机、临床研究。
大学医院神经外科诊所。
40例年龄在18至55岁之间、计划进行脑肿瘤手术的患者。
20例患者用芬太尼和硫喷妥钠诱导麻醉，并用芬太尼、氟哌利多、异氟烷、氧化亚氮（N2O）和硫喷妥钠输注维持麻醉。20例患者先静脉注射负荷量丙泊酚，然后以固定速率持续输注维持。此外，先静脉注射负荷量阿芬太尼，随后以可变速率输注，并根据需要追加剂量以维持血流动力学稳定。
硫喷妥钠诱导后血压（BP）下降，随后在插管期间BP和心率（HR）显著升高。丙泊酚负荷输注期间BP和HR未发生变化。然而，注射阿芬太尼后BP出现类似下降，并在插管期间恢复至基线值。与硫喷妥钠治疗的患者相比，丙泊酚 - 阿芬太尼治疗的患者恢复正常定向（7±5分钟对27±23分钟）和注意力集中（12±12分钟对35±37分钟）的时间更短且更可预测。维持丙泊酚浓度（9例患者）在3±0.69微克/毫升至3.36±1.17微克/毫升之间，而苏醒时浓度为1.09微克/毫升。拔管时阿芬太尼浓度（9例患者）为79±34纳克/毫升。
丙泊酚和阿芬太尼的全静脉麻醉技术是基于硫喷妥钠、N2O、芬太尼和异氟烷的常用技术的一种有价值的替代方法。
