Kerkkamp H E, Gielen M J
Institute for Anesthesiology, University of Nijmegen, Academic Hospital, The Netherlands.
Reg Anesth. 1990 May-Jun;15(3):137-41.
Twenty patients scheduled for elective urologic surgery received epidural anesthesia with 20 ml 0.5% bupivacaine. Ten patients received an epinephrine-free solution and ten patients received epinephrine 5 micrograms.ml-1 added to the local anesthetic solution. The mean maximum level of sensory blockade was not different between the two groups (T7 and T8). After epidural administration of 20 ml of either solution, the mean arterial blood pressure decreased significantly from pre-blockade values. After administration of 0.5% bupivacaine with epinephrine, cardiac output, stroke volume and end diastolic volume increased significantly from pre-blockade control values. These changes occurred within two to four minutes after injection of the local anesthetic solution and are caused by the systemic effects of epinephrine. After 15 minutes, the ejection fraction in the plain bupivacaine group decreased significantly from pre-blockade control values and the bupivacaine with epinephrine group. The differences in hemodynamic effects of the two solutions can be explained by the vasoactive effects of epinephrine and the cardiodepressive effects of bupivacaine.
20例计划接受择期泌尿外科手术的患者接受了20毫升0.5%布比卡因的硬膜外麻醉。10例患者接受不含肾上腺素的溶液，10例患者接受加入5微克/毫升肾上腺素的局部麻醉溶液。两组之间感觉阻滞的平均最高平面无差异（T7和T8）。硬膜外给予任一溶液20毫升后，平均动脉血压较阻滞前值显著降低。给予含肾上腺素的0.5%布比卡因后，心输出量、每搏量和舒张末期容积较阻滞前对照值显著增加。这些变化在注射局部麻醉溶液后两到四分钟内出现，是由肾上腺素的全身作用引起的。15分钟后，单纯布比卡因组和布比卡因加肾上腺素组的射血分数均较阻滞前对照值显著降低。两种溶液血流动力学效应的差异可由肾上腺素的血管活性作用和布比卡因的心脏抑制作用来解释。
