Ewalenko P, Deloof T, Gerin M, Delmotte J J, Byttebier G
Anesthesia Departments of the Institute J. Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles.
Acta Anaesthesiol Belg. 1990;41(4):297-306.
20 patients (ASA I to III) scheduled for microlaryngoscopy were randomly allocated to receive by infusion either 12-15 mg/kg/h propofol alone (group A) or 6-9 mg/kg/h with fentanyl supplementation (group B). All patients were premedicated with oral diazepam one hour before the procedure; they received an induction dose of 2 mg/kg propofol, preceded in group B by a bolus dose of fentanyl 1 microgram/kg. Significant hypotension was observed at induction in both groups to a similar degree (A:--26%; B:--30.2% compared to baseline). Placement of the laryngoscope induced sustained hypertension throughout the procedure in both groups (A: +28%; B: +20%) subsiding only at the removal of the instrument. Heart rate was never significantly altered. Arterial blood concentrations of propofol at induction reached high peak values (A: 16.82 +/- 8.52 micrograms/ml--B: 19.52 +/- 8.87 micrograms/ml--mean +/- SD) then remained stable throughout the procedure (A: 5.44 +/- 1.40 micrograms/ml--B: 2.91 +/- 1.06 micrograms/ml). At awakening, they were lower in group B (0.62 +/- 0.2 micrograms/ml) than in group A (1.17 +/- 0.55 micrograms/ml--p less than 0.05). Recovery was a little faster in group A (at the limit of significance). Though patients may present some excitation at awakening, recovery was usually very pleasant and characterized by swift return to consciousness, alertness and of all reflexes. We conclude that a propofol infusion is particularly suitable for microlaryngeal surgery. The addition of a narcotic agent allows reduction of the propofol dose range and does not alter recovery significantly. The proper dose of narcotic agent necessary to abolish cardiovascular reactivity to laryngoscopy must still be ascertained.
20例计划行显微喉镜检查的患者（ASA分级I至III级）被随机分配，通过静脉输注分别单独给予12 - 15mg/kg/h丙泊酚（A组）或6 - 9mg/kg/h丙泊酚并补充芬太尼（B组）。所有患者在手术前1小时口服地西泮进行术前用药；他们均接受2mg/kg丙泊酚的诱导剂量，B组在给予丙泊酚前先给予1μg/kg的芬太尼推注剂量。两组在诱导期均观察到相似程度的显著低血压（A组：较基线下降26%；B组：较基线下降30.2%）。两组在整个手术过程中，喉镜置入均引起持续高血压（A组：升高28%；B组：升高20%），仅在器械移除时血压才下降。心率从未有显著改变。诱导时丙泊酚的动脉血浓度达到高峰值（A组：16.82±8.52μg/ml - B组：19.52±8.87μg/ml - 均值±标准差），然后在整个手术过程中保持稳定（A组：5.44±1.40μg/ml - B组：2.91±1.06μg/ml）。苏醒时，B组（0.62±0.2μg/ml）低于A组（1.17±0.55μg/ml - p<0.05）。A组恢复稍快（接近显著差异）。尽管患者苏醒时可能出现一些兴奋，但恢复过程通常非常顺利，其特点是迅速恢复意识、警觉和所有反射。我们得出结论，丙泊酚静脉输注特别适用于显微喉镜手术。添加麻醉剂可降低丙泊酚的剂量范围，且对恢复无显著影响。仍需确定消除喉镜检查引起的心血管反应所需的合适麻醉剂剂量。
