Lemmens H J, Bovill J G, Hennis P J, Gladines M P, Burm A G
Department of Anesthesiology, University Hospital, Leiden, The Netherlands.
Anesthesiology. 1989 Nov;71(5):669-74. doi: 10.1097/00000542-198911000-00008.
Two groups of women, ASA physical status 1, undergoing surgery for primary breast cancer, were studied to assess the effect of alcohol intake on alfentanil pharmacodynamics. Patients in group 1 (n = 6) had an average daily consumption of 20-40 g alcohol. Patients in group 2 (n = 8) were life-long abstainers or drank only occasionally (less than 60 g per year). Anesthesia was induced and maintained with 66% N2O in O2 and alfentanil. Alfentanil was administered by a computer-controlled infusion pump. If during surgery the patient exhibited somatic, hemodynamic, or other autonomic signs of inadequate anesthesia (response), the target alfentanil plasma concentration was increased by 50-100 ng/ml. If there was no response during a 15-min period, the target concentration was decreased by 50-100 ng/ml. Arterial blood samples were taken before any change of the target concentration, 4 min after a new predicted target concentration was achieved, and at extubation. Plasma concentrations were determined by capillary gas chromatography. Alfentanil protein binding was measured by equilibrium dialysis. Plasma alfentanil concentration-effect data were analyzed by nonlinear regression, where effect was either response or no response to surgical stimuli. The average total alfentanil requirement was significantly (P less than 0.005) higher in group 1 (3.7 +/- 1.2 micrograms.kg-1.min-1) than in group 2 (1.9 +/- 0.4 micrograms.kg-1.min-1). The average Cp50 (the plasma concentration for which the probability of no response during surgery is 50%) was significantly (P less than 0.001) higher in group 1 (522 +/- 104 ng/ml) than in group 2 (208 +/- 26 ng/ml).(ABSTRACT TRUNCATED AT 250 WORDS)
对两组美国麻醉医师协会（ASA）身体状况为1级、接受原发性乳腺癌手术的女性进行了研究，以评估酒精摄入对阿芬太尼药效学的影响。第1组患者（n = 6）平均每日酒精摄入量为20 - 40克。第2组患者（n = 8）为终身戒酒者或仅偶尔饮酒（每年少于60克）。采用66%的氧化亚氮（N₂O）与氧气混合并加阿芬太尼诱导和维持麻醉。阿芬太尼通过计算机控制的输液泵给药。如果手术过程中患者出现躯体、血流动力学或其他麻醉不足的自主体征（反应），则将目标阿芬太尼血浆浓度提高50 - 100纳克/毫升。如果在15分钟内无反应，则将目标浓度降低50 - 100纳克/毫升。在目标浓度任何改变之前、达到新的预测目标浓度4分钟后以及拔管时采集动脉血样本。血浆浓度通过毛细管气相色谱法测定。阿芬太尼蛋白结合通过平衡透析法测量。血浆阿芬太尼浓度 - 效应数据通过非线性回归分析，其中效应为对手术刺激有反应或无反应。第1组的平均阿芬太尼总需求量（3.7±1.2微克·千克⁻¹·分钟⁻¹）显著高于第2组（1.9±0.4微克·千克⁻¹·分钟⁻¹）（P＜0.005）。第1组的平均半数有效浓度（Cp50，即手术期间无反应概率为50%时的血浆浓度）（522±104纳克/毫升）显著高于第2组（208±26纳克/毫升）（P＜0.001）。（摘要截选至250字）
