Hagiwara Ayano, Matsuura Nobuyuki, Ichinohe Tatsuya
Postgraduate student, Department of Dental Anesthesiology, Tokyo Dental College, Chiba, Japan.
Associate Professor, Department of Dental Anesthesiology, Tokyo Dental College, Chiba, Japan.
J Oral Maxillofac Surg. 2018 Jan;76(1):52-59. doi: 10.1016/j.joms.2017.05.038. Epub 2017 Jun 12.
The aim of this study was to compare changes in respiratory dynamics starting immediately after administration of propofol alone or a combination of propofol and midazolam.
Twenty-seven healthy adult volunteers participated in a randomized crossover study of undergoing sedation with propofol alone (P group) or with a combination of propofol and midazolam (PM group). In the P group, continuous infusion of propofol through a target-controlled infusion (TCI) pump was started with the target effect site (ES) concentration set at 1.2 μg/mL. In the PM group, participants received a bolus administration of midazolam 0.02 mg/kg simultaneously with the start of continuous infusion of propofol through a TCI pump with the target ES concentration set at 0.8 μg/mL. The variables measured included the bispectral index (BIS) value, tidal volume (VT), percutaneous arterial oxygen saturation (SpO), respiratory rate (RR), end-tidal carbon dioxide tension (ETCO), estimated ES propofol concentration, and minute volume.
BIS value, VT, SpO, and ETCO decreased after sedative administration in the 2 groups. RR increased in the 2 groups. These changes occurred sooner in the PM group than in the P group. The ratio of change in VT to change in BIS value decreased in the 2 groups and was markedly smaller in the PM group than in the P group. Ratios of changes in SpO, RR, and ETCO to change in BIS value increased in the 2 groups and were larger in the PM group than in the P group.
Changes in respiratory dynamics occurred sooner in the PM group than in the P group. In the PM group, although VT began to decrease before the change in BIS value, the increase in RR caused the rate of decrease in SpO to be smaller than the rate of decrease in BIS value.
本研究旨在比较单独给予丙泊酚或丙泊酚与咪达唑仑联合用药后即刻开始的呼吸动力学变化。
27名健康成年志愿者参与了一项随机交叉研究，分别接受单独丙泊酚镇静（P组）或丙泊酚与咪达唑仑联合镇静（PM组）。在P组中，通过靶控输注（TCI）泵持续输注丙泊酚，靶效应室（ES）浓度设定为1.2μg/mL。在PM组中，参与者在通过TCI泵开始持续输注丙泊酚时，同时静脉推注咪达唑仑0.02mg/kg，靶ES浓度设定为0.8μg/mL。测量的变量包括脑电双频指数（BIS）值、潮气量（VT）、经皮动脉血氧饱和度（SpO）、呼吸频率（RR）、呼气末二氧化碳分压（ETCO）、估计的ES丙泊酚浓度和分钟通气量。
两组在给予镇静药物后BIS值、VT、SpO和ETCO均下降。两组的RR均升高。这些变化在PM组比在P组发生得更早。两组中VT变化与BIS值变化的比值均下降，且PM组明显小于P组。两组中SpO、RR和ETCO变化与BIS值变化的比值均升高，且PM组大于P组。
PM组呼吸动力学变化比P组发生得更早。在PM组中，尽管VT在BIS值变化之前就开始下降，但RR的增加导致SpO的下降速率小于BIS值的下降速率。
