Taghavi Gilani Mehryar, Razavi Majid
Anesthesia Department, Imam-Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Case Rep Anesthesiol. 2013;2013:852143. doi: 10.1155/2013/852143. Epub 2013 Apr 3.
Opioids have been considered for their hemodynamic stability. Remifentanil is an opioid analgesic with rapid metabolism and fast primary effect and recovery. In this paper, a very rare effect of using remifentanil along with propofol was presented. An 84-year-old male patient with severe aortic stenosis underwent general anesthesia. In order to induce anesthesia and maintain it, fentanyl, pancuronium, and propofol, along with a combination of propofol and remifentanil, were used, respectively. At beginning of remifentanil infusion, bradycardia and then Mobitz type II conduction block with a hemodynamic disorder occurred for the patient. The decreased blood pressure responded to injection of atropine and ephedrine; however, dysrhythmia only improved after cessation of remifentanil. Therefore remifentanil should be used with caution in aortic stenosis.
阿片类药物因其血流动力学稳定性而受到关注。瑞芬太尼是一种代谢迅速、起效快且恢复快的阿片类镇痛药。本文介绍了使用瑞芬太尼与丙泊酚联合时一种非常罕见的效应。一名84岁患有严重主动脉瓣狭窄的男性患者接受全身麻醉。为诱导和维持麻醉,分别使用了芬太尼、潘库溴铵和丙泊酚,以及丙泊酚与瑞芬太尼的联合用药。在输注瑞芬太尼开始时,该患者出现心动过缓,随后出现莫氏Ⅱ型传导阻滞并伴有血流动力学紊乱。血压下降对注射阿托品和麻黄碱有反应;然而,心律失常仅在停用瑞芬太尼后才有所改善。因此,在主动脉瓣狭窄患者中应谨慎使用瑞芬太尼。