McMurray T J, Collier P S, Carson I W, Lyons S M, Elliott P
Department of Clinical Anaesthesia, Royal Victoria Hospital, Belfast.
Anaesthesia. 1990 Apr;45(4):322-6. doi: 10.1111/j.1365-2044.1990.tb14743.x.
One hundred adult patients who required mechanical ventilation after open heart surgery for coronary revascularisation were studied. All received a standard premedication and a high dose opioid anaesthetic. On arrival in the intensive care unit they were allocated randomly to receive either propofol or midazolam to maintain sedation within a predetermined range. Patients who received propofol underwent extubation of the trachea, using standard criteria, after a mean time (log-transformed) of 7.6 minutes after sedation for approximately 17 hours. The corresponding time was 125 minutes in those given midazolam. There were significantly higher morphine requirements during sedation, and higher arterial carbon dioxide tensions 30 minutes after extubation of the trachea, in patients who received midazolam. Pharmacokinetic analysis in 20 patients showed that the elimination half-life of propofol was prolonged (470 minutes) and clearance was reduced (1.14 litres/minute) compared with subjects who had not undergone cardiopulmonary bypass. The rapid clinical recovery was reflected in a rapid redistribution half-life (13.4 minutes), but this was also longer than the redistribution time of 2-4 minutes in other patients.
对100例接受冠状动脉血运重建心脏直视手术后需要机械通气的成年患者进行了研究。所有患者均接受标准的术前用药和高剂量阿片类麻醉剂。抵达重症监护病房后，他们被随机分配接受丙泊酚或咪达唑仑，以将镇静维持在预定范围内。接受丙泊酚的患者在镇静约17小时后，平均时间（对数转换）为7.6分钟时，按照标准标准进行气管拔管。给予咪达唑仑的患者相应时间为125分钟。接受咪达唑仑的患者在镇静期间吗啡需求量显著更高，气管拔管后30分钟时动脉血二氧化碳分压更高。对20例患者的药代动力学分析表明，与未接受体外循环的受试者相比，丙泊酚的消除半衰期延长（470分钟），清除率降低（1.14升/分钟）。快速的临床恢复体现在快速的再分布半衰期（13.4分钟）上，但这也比其他患者2 - 4分钟的再分布时间长。
