Badgwell J M, Heavner J E, Cooper M W, Cockings E
Department of Anesthesiology, Texas Tech University Health Sciences Center, School of Medicine, Lubbock.
Acta Anaesthesiol Scand. 1988 Jul;32(5):383-7. doi: 10.1111/j.1399-6576.1988.tb02750.x.
The cardiovascular effects of anticholinergic agents administered during halothane anaesthesia were studied in 31 children aged 1-12 years undergoing peripheral orthopaedic surgery. Either normal saline, glycopyrrolate (10 micrograms.kg-1) or atropine (20 micrograms.kg-1) was administered in randomized double-blind fashion during the induction of anaesthesia with halothane while the electrocardiogram was continuously recorded. After induction, the children were paralyzed with atracurium, intubated, and ventilated. Anaesthesia was maintained with N2O/O2 and halothane (up to 2.5% inspired). The concentrations of expired CO2 and halothane were measured continuously using mass spectrometry. Sixty-one percent (19/31) of the children developed one or more dysrhythmias. Junctional rhythm occurred in 74% (14/19) of the children with dysrhythmias, developed early during induction (mean +/- s.d. time = 2.29 +/- 2.0 min after commencement of induction), and usually resolved before the administration of the study drug (8/14). All dysrhythmias initially occurred before or during induction and none developed during intubation, during incision, during the maintenance of anaesthesia, or after the administration of anticholinergic agents. The data suggest that: 1) a combination of factors present during halothane induction is highly dysrhythmogenic especially for junctional rhythm; 2) junctional rhythm will resolve spontaneously; 3) the administration of an anticholinergic agent during halothane induction is safe but may be unnecessary in children greater than 1 year of age; and 4) the dysrhythmogenic factors present during induction are attenuated during the maintenance of halothane anaesthesia.
对31名年龄在1至12岁、正在接受外周骨科手术的儿童，研究了氟烷麻醉期间给予抗胆碱能药物的心血管效应。在氟烷麻醉诱导期间，以随机双盲方式给予生理盐水、格隆溴铵（10微克·千克⁻¹）或阿托品（20微克·千克⁻¹），同时持续记录心电图。诱导后，儿童用阿曲库铵使其肌肉松弛，进行插管并通气。用氧化亚氮/氧气和氟烷（吸入浓度高达2.5%）维持麻醉。使用质谱法持续测量呼出二氧化碳和氟烷的浓度。61%（19/31）的儿童出现一种或多种心律失常。74%（14/19）出现心律失常的儿童发生交界性心律，在诱导早期出现（诱导开始后平均±标准差时间 = 2.29±2.0分钟），且通常在给予研究药物前消失（8/14）。所有心律失常最初均在诱导前或诱导期间出现，插管期间、切口期间、麻醉维持期间或给予抗胆碱能药物后均未出现。数据表明：1）氟烷诱导期间存在的多种因素具有高度致心律失常性，尤其是对交界性心律；2）交界性心律会自发消失；3）氟烷诱导期间给予抗胆碱能药物是安全的，但对1岁以上儿童可能不必要；4）诱导期间存在的致心律失常因素在氟烷麻醉维持期间会减弱。
