Schaer H, Baasch K, Achtari R
Anaesthesie-Abteilung, Kreisspital Männedorf, Schweiz.
Anaesthesist. 1990 Jan;39(1):26-32.
The new benzodiazepine antagonist flumazenil represents another approach to the ever-present problem of recurring respiratory depression after anesthesia with flunitrazepam and fentanyl. Objective and subjective side effects of flumazenil were studied in comparison with the opiate antagonists naloxone and nalbuphine. METHODS. One hundred fifty surgical patients, ASA I or II, aged 18-65 years were studied. After premedication with atropine 0.5 mg and flunitrazepam 0.5 mg anesthesia was induced with flunitrazepam 0.5 mg, fentanyl 0.1 mg and etomidate 10 mg and maintained with N2O/O2 2:1 and additional increments of 0.1 mg fentanyl as required. Relaxation for intubation and surgery was obtained with non depolarizing muscle relaxants. After the operation the patients were extubated and then flumazenil 0.4 mg, naloxone 0.05 mg, or nalbuphine 20 mg was given i.v. (randomized and double-blind). In 15 patients blood pressure and heart rate were monitored. In all patients postoperative pain was assessed by the time interval between administration of the antagonist and need for the first analgesic medication. On the 1st postoperative day recall of postoperative events and of pictures shown 5, 30, 60, 120, and 240 min after administration of the antagonist was tested. The patients were interviewed a second time for side effects on day 3-6 after the operation. RESULTS. The three antagonists produced no significant effects on arterial pressure and heart rate. There were no differences between the antagonists in the incidence of postoperative nausea and/or vomiting or postoperative pain. After flumazenil, a significant transient increase in vigilance and better recall of postoperative events was noted within 5 and 30 min after administration of the drug. CONCLUSION. On the basis of the objective clinical findings, there is no reason to prefer either benzodiazepine or opiate antagonists after flunitrazepam and fentanyl. However, postoperative amnesia can be reduced by flumazenil if this is desirable.
新型苯二氮䓬拮抗剂氟马西尼为解决使用氟硝西泮和芬太尼麻醉后反复出现的呼吸抑制这一常见问题提供了另一种方法。将氟马西尼的客观和主观副作用与阿片类拮抗剂纳洛酮和纳布啡进行了比较研究。方法：研究了150例年龄在18至65岁之间、ASA I或II级的外科手术患者。在给予0.5mg阿托品和0.5mg氟硝西泮进行术前用药后，用0.5mg氟硝西泮、0.1mg芬太尼和10mg依托咪酯诱导麻醉，并用N2O/O2 2:1维持麻醉，并根据需要额外追加0.1mg芬太尼。使用非去极化肌肉松弛剂实现插管和手术所需的肌肉松弛。手术后患者拔管，然后静脉注射0.4mg氟马西尼、0.05mg纳洛酮或20mg纳布啡（随机双盲）。对15例患者监测血压和心率。在所有患者中，通过拮抗剂给药至首次需要镇痛药物的时间间隔来评估术后疼痛。在术后第1天，测试患者对拮抗剂给药后5、30、60、120和240分钟所展示图片以及术后事件的回忆情况。在术后第3至6天对患者进行第二次访谈以了解副作用情况。结果：三种拮抗剂对动脉压和心率均无显著影响。拮抗剂在术后恶心和/或呕吐发生率或术后疼痛方面无差异。给予氟马西尼后，在给药后5至30分钟内观察到警觉性显著短暂提高以及对术后事件的回忆更好。结论：基于客观临床发现，在使用氟硝西泮和芬太尼后，没有理由更倾向于使用苯二氮䓬拮抗剂或阿片类拮抗剂。然而，如果需要，氟马西尼可减轻术后遗忘。
