Henderson J M, Brodsky D A, Fisher D M, Brett C M, Hertzka R E
Department of Anesthesia, University of California, San Francisco 94143-0648.
Anesthesiology. 1988 May;68(5):671-5. doi: 10.1097/00000542-198805000-00003.
To evaluate nasally administered sufentanil, 1.5-4.5 micrograms/kg, for pre-induction (i.e., pre-medication/induction) of anesthesia in pediatric patients, the authors studied ASA PS 1 or 2 patients scheduled for elective surgery. Eighty children, ages 6 months to 7 yr, were randomized to receive sufentanil (1.5, 3.0, or 4.5 micrograms/kg) or placebo (normal saline, 0.03 ml/kg) nasally over 15-20 s. Induction of anesthesia was completed with 5% halothane and O2 via facemask. After tracheal intubation, anesthesia was maintained with N2O (60-70%) and halothane, as clinically indicated. A blinded observer remained with the child from prior to drug administration until discharge from the recovery room. Patients given sufentanil were more likely to separate willingly from their parents and be judged as calm at or before 10 min compared to those given saline. Ventilatory compliance during induction of anesthesia decreased markedly in 25% of subjects given sufentanil, 4.5 micrograms/kg. Subjects given sufentanil moved or coughed less during tracheal intubation and required less halothane compared to those given placebo. During recovery, patients given sufentanil cried less and fewer needed analgesics; recovery times were similar for all groups. However, patients given sufentanil, 4.5 micrograms/kg, had a higher incidence of vomiting in the recovery room and during the first postoperative day. The authors conclude that nasally administered sufentanil, 1.5 or 3.0 micrograms/kg, facilitates separation of children from parents, has minimal side effects, may improve intubating conditions, and can provide postoperative analgesia.
为评估经鼻给予1.5 - 4.5微克/千克舒芬太尼用于小儿患者麻醉诱导前（即术前用药/诱导）的效果，作者对计划进行择期手术的美国麻醉医师协会（ASA）身体状况分级为1或2级的患者进行了研究。80名年龄在6个月至7岁的儿童被随机分组，在15 - 20秒内经鼻给予舒芬太尼（1.5、3.0或4.5微克/千克）或安慰剂（生理盐水，0.03毫升/千克）。通过面罩用5%的氟烷和氧气完成麻醉诱导。气管插管后，根据临床指征用氧化亚氮（60 - 70%）和氟烷维持麻醉。一名盲法观察者在给药前至患儿从恢复室出院期间一直陪伴。与给予生理盐水的患儿相比，给予舒芬太尼的患儿更有可能愿意与父母分开，并且在10分钟时或之前被判定为平静。给予4.5微克/千克舒芬太尼的受试者中，25%在麻醉诱导期间通气顺应性显著下降。与给予安慰剂的受试者相比，给予舒芬太尼的受试者在气管插管期间移动或咳嗽较少，且所需氟烷较少。在恢复过程中，给予舒芬太尼的患儿哭闹较少，需要镇痛剂的患儿也较少；所有组的恢复时间相似。然而，给予4.5微克/千克舒芬太尼的患儿在恢复室和术后第一天呕吐的发生率较高。作者得出结论，经鼻给予1.5或3.0微克/千克舒芬太尼有助于小儿与父母分离，副作用最小，可能改善插管条件，并可提供术后镇痛。
