Mourand J L, Neidhardt-Audion M, Schipman N, Lec G, Neidhardt A, Clément F, Etievent J P
Département d'Anesthésie-Réanimation, C.H.U. 25000 Besançon.
Cah Anesthesiol. 1987 Oct;35(6):445-7.
20 patients undergoing thoracic surgery were studied. Before anaesthesia either a catheter was placed in the intercostal space, at the same level as the thoracotomy (16 patients) or an epidural catheter was inserted if there was a contraindication of intercostal blockade (4 patients). Marcaine 0.5--was injected. Anaesthesia was induced with propofol 2.5 mg.kg-1, vecuronium 0.1 mg.kg-1, dextromoramide 50 mcg.kg-1. It was maintained with propofol 9 mg.kg-1.h-1 for 30 mn, then 4.5 mg.kg-1.h-1 for following hours (by a syringe pump) and vecuronium 0.1 mg.kg-1.h-1. Cardio vascular effects were studied only in the 16 patients with intercostal blockade: during induction bradycardia in 3 patients, and systolic arterial pressure (S.A.P.) decrease of 30% in 8 patients were observed. After the incision, heart rate and S.A.P. became steady. The average duration of anaesthesia was 214 min +/- 74. The time from the end of propofol infusion to the moment of extubation was 15.4 min +/- 33 and the time to recover all mental faculties was 46 mn +/- 11. 30 min after the end of anaesthesia the maxima minute ventilation was equal to the post operative value at 48 H. Propofol anaesthesia allows a fast awakening, without cumulative effects.
对20例接受胸外科手术的患者进行了研究。麻醉前,16例患者在与开胸手术相同水平的肋间间隙放置导管,4例因肋间阻滞禁忌证而插入硬膜外导管。注射了0.5%的布比卡因。用丙泊酚2.5mg·kg⁻¹、维库溴铵0.1mg·kg⁻¹、右吗拉胺50μg·kg⁻¹诱导麻醉。最初30分钟用丙泊酚9mg·kg⁻¹·h⁻¹维持麻醉,随后数小时用4.5mg·kg⁻¹·h⁻¹(通过注射泵),并用维库溴铵0.1mg·kg⁻¹·h⁻¹。仅对16例接受肋间阻滞的患者研究了心血管效应:诱导期间,3例患者出现心动过缓,8例患者收缩压(S.A.P.)下降30%。切口后,心率和S.A.P.趋于稳定。平均麻醉持续时间为214分钟±74分钟。从丙泊酚输注结束至拔管的时间为15.4分钟±33分钟,恢复所有精神功能的时间为46分钟±11分钟。麻醉结束后30分钟,最大分钟通气量等于术后48小时的值。丙泊酚麻醉可实现快速苏醒,且无累积效应。