Kumazawa T, Yamaguchi T, Nakano S, Kume M, Oguchi T, Tanaka Y, Manabe M, Miyaji T, Abe F, Matsukawa T
Department of Anesthesia, Yamanashi Medical College.
Masui. 1990 May;39(5):544-53.
An epidural catheter was inserted at T9-L2 interspace and 10 micrograms.kg-1 fentanyl with (E+) or without (E-) epinephrine 1:100,000 was given for 82 elective abdominal surgeries. N2O 66%, enflurane and muscle relaxant were used as needed. The onset and the duration of the action were estimated to be approximately 15 minutes and 4 hours, respectively. Anesthesia was maintained with enflurane below 0.4% (0.22 +/- 0.09%) in 70 patients (85.4%). E+ group needed significantly lower concentration of enflurane than E- group. There was no severe hemodynamic change during the operation. Systolic pressure, diastolic pressure and heart rate during the operation were 115.2 +/- 16.0 mmHg, 69.4 +/- 10.8 mmHg and 74.2 +/- 11.4 min-1, respectively, each of which was about 18% less than the values on arrival in the operating room. Sixty-one patients (82.5%) woke rapidly. Almost all patients felt well and had no pain during the recovery period. Naloxone 0.05-4 mg was administered intravenously in 21 patients (31.7%) whose respiratory rate was below 10 min-1. The patients with shorter operation time (shorter than 2.5 hours) needed more naloxone. Troubles of respiratory depression did not occur in the recovery room and in the ward in both naloxone and non-naloxone groups. This anesthesia method which induces mild depression of blood pressure and heart rate may be indicated for patients with ischemic heart disease or with poor cardiac function, but has no advantages in patients with poor respiratory function who need early extubation after a short operation.
在T9 - L2椎间隙插入硬膜外导管，对82例择期腹部手术患者给予10微克/千克芬太尼，其中（E +）组添加1:100,000肾上腺素，（E -）组未添加。根据需要使用66%的氧化亚氮、恩氟烷和肌肉松弛剂。起效时间和作用持续时间估计分别约为15分钟和4小时。70例患者（85.4%）使用浓度低于0.4%（0.22±0.09%）的恩氟烷维持麻醉。E +组所需的恩氟烷浓度明显低于E -组。术中无严重血流动力学变化。术中收缩压、舒张压和心率分别为115.2±16.0 mmHg、69.4±10.8 mmHg和74.2±11.4次/分钟，均比进入手术室时的值低约18%。61例患者（82.5%）苏醒迅速。几乎所有患者在恢复期感觉良好且无疼痛。21例呼吸频率低于10次/分钟的患者（31.7%）静脉注射了0.05 - 4毫克纳洛酮。手术时间较短（短于2.5小时）的患者需要更多纳洛酮。纳洛酮组和非纳洛酮组在恢复室和病房均未发生呼吸抑制问题。这种引起血压和心率轻度下降的麻醉方法可能适用于缺血性心脏病或心功能较差的患者，但对于呼吸功能差且短时间手术后需要早期拔管的患者并无优势。
