Politis George D, Stemland Christopher J, Balireddy Ravi K, Brockhaus Julie, Hughes Kevin R, Goins Matthew D, McMurry Timothy L
Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA 22908, USA.
Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA 22908, USA.
J Clin Anesth. 2014 Feb;26(1):25-35. doi: 10.1016/j.jclinane.2013.08.005. Epub 2014 Jan 17.
To determine, for two different age groups, the effect of duration of sevoflurane administration on the amount of propofol needed when performing tracheal intubation.
Classic Dixon's Up-and-Down sequential method.
University based operating rooms.
106 ASA physical status 1 and 2 patients aged one to 11 years.
Patients were allocated to the 1-6 year (≥ 12 and < 72 mos) and 6-11 year (≥ 72 and < 132 mos) age groups. Midazolam 0.5 mg/kg was given orally to the 1-6 year group, and all patients were induced with 8% dialed sevoflurane and 67% nitrous oxide (N2O), with N2O discontinued and sevoflurane dialed to 5% after one minute and 1.5 minutes for the younger and older age groups, respectively. Intravenous access was obtained and propofol was promptly administered. Propofol dose was determined according to age group and whether propofol was given 2-4, 4-6, or 6-8 minutes after the start of sevoflurane induction, with Dixon's Up and Down Method used separately for each specific age/time group. Tracheal intubation conditions one minute after propofol were evaluated.
Isotonic regression determined propofol ED50 estimates for excellent tracheal intubation conditions, and linear regression determined the effect of propofol dose on change in systolic blood pressure (SBP).
Estimated propofol ED50 doses for 1-6 year olds, with 95% confidence intervals (CIs), were 1.48 mg/kg (0.80, 2.03), 0.00 mg/kg (0.00, 0.38), and 0.07 mg/kg (0.00, 0.68) in the 2-4, 4-6, and 6-8 minute groups, respectively, with estimated differences between the 2-4 minute group versus the 4-6 and 6-8 minute groups being 1.47 mg/kg (95% CI = 1.04, 2.06) and 1.41 mg/kg (95% CI = 0.74, 2.04), respectively. Estimated propofol ED50 doses for 6-11 year olds, with 95% CIs, were 2.35 mg/kg (1.97, 2.45) and 2.33 mg/kg (1.59, 2.45) in the 2-4 and 4-6 minute groups, respectively. Diminutions in SBP at one minute and two minutes after propofol administration were dose dependent for children 1-6 years of age, decreasing 5.3% and 8.1% for each 1 mg/kg of propofol, respectively.
The amount of propofol needed to supplement sevoflurane in children 1-6 years of age can be expected to decrease after 4 minutes of sevoflurane.
确定两个不同年龄组中，七氟醚给药持续时间对气管插管时所需丙泊酚用量的影响。
经典的狄克逊上下序贯法。
大学附属医院手术室。
106例美国麻醉医师协会（ASA）身体状况分级为1级和2级、年龄在1至11岁的患者。
患者被分为1 - 6岁（≥12个月且<72个月）和6 - 11岁（≥72个月且<132个月）年龄组。1 - 6岁组口服咪达唑仑0.5mg/kg，所有患者均用8%设定浓度的七氟醚和67%氧化亚氮（N2O）诱导，1分钟和1.5分钟后（分别针对较年幼和较年长年龄组）停用N2O并将七氟醚浓度调至5%。建立静脉通路后立即给予丙泊酚。根据年龄组以及丙泊酚在七氟醚诱导开始后2 - 4分钟、4 - 6分钟或6 - 8分钟给予，采用狄克逊上下法分别针对每个特定年龄/时间组确定丙泊酚剂量。评估丙泊酚给药1分钟后的气管插管条件。
等渗回归确定用于良好气管插管条件的丙泊酚半数有效剂量（ED50）估计值，线性回归确定丙泊酚剂量对收缩压（SBP）变化的影响。
1 - 6岁组在2 - 4分钟、4 - 6分钟和6 - 8分钟组中，估计的丙泊酚ED50剂量及其95%置信区间（CI）分别为1.48mg/kg（0.80，2.03）、0.00mg/kg（0.00，0.38）和0.07mg/kg（0.00，0.68），2 - 4分钟组与4 - 6分钟组和6 - 8分钟组之间的估计差异分别为1.47mg/kg（95%CI = 1.04，2.06）和1.41mg/kg（95%CI = 0.74，2.04）。6 - 11岁组在2 - 4分钟和4 - 6分钟组中，估计的丙泊酚ED50剂量及其95%CI分别为2.35mg/kg（1.97，2.45）和2.33mg/kg（1.59，2.45）。1 - 6岁儿童在丙泊酚给药后1分钟和2分钟时收缩压的降低呈剂量依赖性，每1mg/kg丙泊酚分别降低5.3%和8.1%。
预计七氟醚给药4分钟后，1 - 6岁儿童补充七氟醚所需的丙泊酚量会减少。
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