Hartung H J
Institut für Anaesthesiologie und Reanimation, Universität Heidelberg.
Anaesthesist. 1988 Oct;37(10):620-4.
Three randomized groups of patients scheduled for upper abdominal surgery received either an initial large bolus of alfentanil combined with low concentrations of isoflurane (group 1), an initial small bolus of alfentanil combined with 50% higher isoflurane concentrations than group 1 (group 2), or isoflurane without opioids (group 3). Blood pressure, heart rates, and anesthetic consumptions were measured and recorded, as were side-effects such as thoracic rigidity, bradycardia, and nausea, and postoperative recovery time.
The mean isoflurane concentration in group 1 was 0.8 vol% combined with an average alfentanil bolus of 6.8 mg and three additional doses of 1.1-1.4 mg. Group 2 received a mean isoflurane concentration of 1.3 vol% combined with four additional doses of 1.3-1.7 mg alfentanil. Group 3 needed an average isoflurane concentration of 1.5 vol%. Side effects of alfentanil were prevented by atropine administration; severe complications were not observed. Postoperative recovery time showed significant differences between groups 1 und 2: group 1 patients were awake within 7.5 min and group 2 within 17 min after the operation. No respiratory depression was detected.
Alfentanil combined with volatile anesthetics produced no severe side-effects in patients scheduled for upper abdominal operations. The pharmacokinetics of alfentanil are advantageous with regard to the postoperative period.
三组计划接受上腹部手术的患者被随机分组，分别接受初始大剂量阿芬太尼联合低浓度异氟烷（第1组）、初始小剂量阿芬太尼联合比第1组高50%的异氟烷浓度（第2组）或单纯异氟烷（无阿片类药物，第3组）。测量并记录血压、心率、麻醉药物消耗量，以及胸壁强直、心动过缓和恶心等副作用，还有术后恢复时间。
第1组的平均异氟烷浓度为0.8%（体积分数），平均阿芬太尼初始推注剂量为6.8 mg，另有3次追加剂量，每次1.1 - 1.4 mg。第2组的平均异氟烷浓度为1.3%（体积分数），另有4次追加剂量，每次1.3 - 1.7 mg阿芬太尼。第3组平均需要的异氟烷浓度为1.5%（体积分数）。通过给予阿托品预防了阿芬太尼的副作用；未观察到严重并发症。术后恢复时间在第1组和第2组之间存在显著差异：第1组患者术后7.5分钟内苏醒，第2组患者术后17分钟内苏醒。未检测到呼吸抑制。
阿芬太尼联合挥发性麻醉药对计划接受上腹部手术的患者未产生严重副作用。阿芬太尼的药代动力学在术后阶段具有优势。
