Eason J R, Waldman C S, Sebel P S, Hanson G C
Department of Anesthetics, Kings College Hospital, Denmark Hill, London.
Acta Anaesthesiol Belg. 1988;39(2):79-85.
The use of etomidate and fentanyl infusions to sedate four asthmatics who required artificial ventilation and were receiving high dose steroids is described. The non-asthmatic patients who had not received steroids were also given etomidate combined with either fentanyl or alfentanil by infusion. Use of this sedative technique was suspended in June 1983, following reports of excess mortality associated with the long-term administration of etomidate. Retrospective measurements of plasma cortisols were subnormal in 5 of the 10 patients who did not receive steroids and remained low 12 hours after discontinuation of the infusion in two cases. All the asthmatics survived, but two of the non-asthmatic patients died. Despite its adverse effects, we still feel there may be a place for etomidate infusion in selected asthmatic patients, provided that steroid replacement is given.
本文描述了使用依托咪酯和芬太尼输注对四名需要人工通气且正在接受大剂量类固醇治疗的哮喘患者进行镇静的情况。未接受类固醇治疗的非哮喘患者也通过输注给予依托咪酯联合芬太尼或阿芬太尼。1983年6月，有报道称长期使用依托咪酯会导致死亡率过高，因此暂停了这种镇静技术的使用。在10名未接受类固醇治疗的患者中，有5名患者的血浆皮质醇回顾性测量结果低于正常水平，其中两例在输注停止12小时后仍维持在低水平。所有哮喘患者均存活，但两名非哮喘患者死亡。尽管有不良反应，但我们仍然认为，在给予类固醇替代治疗的前提下，依托咪酯输注在某些特定的哮喘患者中可能仍有应用价值。
