Thomson I R, Hudson R J, Rosenbloom M, Torchia M G
Department of Anesthesia, University of Manitoba, St Boniface General Hospital, Winnipeg, Canada.
J Cardiothorac Anesth. 1988 Feb;2(1):18-22. doi: 10.1016/0888-6296(88)90142-1.
In a randomized study, the authors examined the changes in plasma epinephrine and norepinephrine concentrations associated with induction of anesthesia and surgery in 33 patients with good ventricular function undergoing elective coronary artery surgery. After premedication with morphine and scopolamine, patients received either fentanyl, 100 micrograms/kg (n = 16), or sufentanil, 15 micrograms/kg, (n = 17), intravenously (IV), over 10 minutes to induce anesthesia. Metocurine, 0.42 mg/kg, IV, produced muscle relaxation. Arterial blood for plasma catecholamine determinations was drawn prior to induction, every two minutes throughout induction, one minute following endotracheal intubation, and one minute after sternotomy. Plasma epinephrine concentration was unchanged with either induction agent. Plasma norepinephrine concentration increased significantly after administration of either narcotic, peaked between six and ten minutes into induction, and returned to the preinduction value after intubation. Induction-related changes in arterial pressure and pulmonary capillary wedge pressure were significantly correlated with changes in the logarithm of plasma norepinephrine concentration. Similar degrees of endogenous norepinephrine release appear to accompany induction with equipotent doses of fentanyl and sufentanil in patients premedicated with morphine and scopolamine. Norepinephrine release may influence the hemodynamic response to induction with narcotics.
在一项随机研究中，作者检查了33例心室功能良好且接受择期冠状动脉手术患者在麻醉诱导和手术过程中血浆肾上腺素和去甲肾上腺素浓度的变化。在给予吗啡和东莨菪碱进行术前用药后，患者静脉注射（IV）芬太尼100微克/千克（n = 16）或舒芬太尼15微克/千克（n = 17），历时10分钟以诱导麻醉。静脉注射0.42毫克/千克的美托库铵以产生肌肉松弛。在诱导前、诱导全过程中每两分钟、气管插管后1分钟以及胸骨切开术后1分钟采集动脉血用于血浆儿茶酚胺测定。两种诱导药物均未使血浆肾上腺素浓度发生变化。给予任何一种麻醉药后，血浆去甲肾上腺素浓度均显著升高，在诱导6至10分钟时达到峰值，并在插管后恢复至诱导前值。诱导相关的动脉压和肺毛细血管楔压变化与血浆去甲肾上腺素浓度对数的变化显著相关。在给予吗啡和东莨菪碱进行术前用药的患者中，等效剂量的芬太尼和舒芬太尼诱导时似乎伴随着相似程度的内源性去甲肾上腺素释放。去甲肾上腺素释放可能会影响对麻醉药诱导的血流动力学反应。
