Anand K J, Sippell W G, Schofield N M, Aynsley-Green A
Department of Anesthesia, Harvard Medical School, Children's Hospital, Boston, Massachusetts 02115.
Br Med J (Clin Res Ed). 1988 Mar 5;296(6623):668-72. doi: 10.1136/bmj.296.6623.668.
Concern about the side effects of various anaesthetic agents in newborn infants has led to the widespread use of anaesthesia with unsupplemented nitrous oxide and oxygen with muscle relaxants in such patients. To investigate the efficacy of such a regimen 36 neonates undergoing operations were randomised to two groups: one group received anaesthesia with nitrous oxide and curare alone and the other was additionally given halothane. Concentrations of metabolites and hormones were measured before and at the end of operation and at six, 12, and 24 hours after operation and the values compared between the two groups. Neonates given halothane anaesthesia showed decreased hormonal responses to operation, with significant differences between the two groups in the changes in adrenaline, noradrenaline, and cortisol concentrations and the ratio of insulin to glucagon concentration. Changes in blood concentrations of glucose and total ketone bodies and plasma concentrations of non-esterified fatty acids were also decreased in neonates receiving halothane anaesthesia. Neonates given anaesthesia with unsupplemented nitrous oxide showed significantly greater increases in the urinary ratio of 3-methylhistidine to creatinine concentration and their clinical condition was also more unstable during and after operation. Unless specifically contraindicated potent anaesthesia with halothane or other anaesthetic agents should be given to all neonates undergoing surgical operations as it decreases their stress responses and improves their clinical stability during and after operation.
对新生儿使用各种麻醉剂副作用的担忧，导致在这类患者中广泛使用单纯氧化亚氮和氧气加肌肉松弛剂的麻醉方法。为了研究这种麻醉方案的效果，将36例接受手术的新生儿随机分为两组：一组仅接受氧化亚氮和箭毒麻醉，另一组额外给予氟烷。在手术前、手术结束时以及术后6小时、12小时和24小时测量代谢产物和激素的浓度，并比较两组之间的数值。接受氟烷麻醉的新生儿对手术的激素反应降低，两组在肾上腺素、去甲肾上腺素和皮质醇浓度变化以及胰岛素与胰高血糖素浓度比值方面存在显著差异。接受氟烷麻醉的新生儿血糖和总酮体的血浓度变化以及非酯化脂肪酸的血浆浓度也降低。仅接受氧化亚氮麻醉的新生儿尿中3-甲基组氨酸与肌酐浓度比值显著升高，且在手术期间和术后其临床状况也更不稳定。除非有特殊禁忌证，所有接受外科手术的新生儿均应给予氟烷或其他麻醉剂的有效麻醉，因为这会降低他们的应激反应，并改善他们在手术期间和术后的临床稳定性。
