Coquelin G, Quinot J F, Donnard G, Rouvin B, Saissy Y M, Chateau J
Service d'Anesthésie-Réanimation, Hôpital d'Instruction des Armées Sainte-Anne, Toulon Naval.
Cah Anesthesiol. 1987 Oct;35(6):449-55.
Two groups of 20 patients scheduled for major abdominal surgery or thoracic surgery received analgesia by thoracic peridural route: 850 and 837 micrograms.kg-1 of bupivacaine, plus 4.30 and 4.20 micrograms.kg-1 of fentanyl. Anaesthesia was induced and maintained with either infusion of propofol 0.2% or infusion of methohexital 0.1% and patients were intubated and ventilated. The quality of induction was good in the two groups (3.48 mg.kg-1 in 4 min with propofol and 2.76 mg.kg-1 in 5 min with methohexital). But only 4 of propofol group needed vecuronium for intubation; they were 19 in the other group. Maintenance was extremely smooth with propofol (0.088 mg.kg-1.min-1) in 18 cases. In contrast, poor anaesthetic control was obtained with 14 methohexital patients and had to be abandoned. Hemodynamic data show fc, Pa and Ppa decreased with propofol but increased with methohexital in response to laryngoscopy and intubation. In this study, the onset of 5 sinusal bradycardias was noted with propofol. Two of them were severe 39 and 38 b.min-1 with major decrease of LVSWI to 32.45 and 24.47 g.mm-2. The role of hypovolemia (Bainbridge reflex) or vagomimetic effect of propofol is discussed. Nevertheless, this study shows that propofol given by infusion can better achieve adequate anaesthesia than methohexital.
两组各20例计划进行腹部大手术或胸科手术的患者接受了经胸段硬膜外途径镇痛：分别给予850和837微克/千克的布比卡因，以及4.30和4.20微克/千克的芬太尼。采用0.2%丙泊酚输注或0.1%美索比妥输注诱导并维持麻醉，患者行气管插管和机械通气。两组诱导质量均良好（丙泊酚组4分钟内用量为3.48毫克/千克，美索比妥组5分钟内用量为2.76毫克/千克）。但丙泊酚组仅4例患者插管时需要使用维库溴铵；另一组则有19例。18例使用丙泊酚维持麻醉的患者过程极其平稳（0.088毫克/千克·分钟）。相比之下，14例使用美索比妥的患者麻醉控制不佳，不得不放弃。血流动力学数据显示，喉镜检查和插管时，丙泊酚使心率、动脉压和肺动脉压降低，而美索比妥则使其升高。本研究中，使用丙泊酚时出现了5例窦性心动过缓。其中2例严重，心率分别为39次/分钟和38次/分钟，左室每搏功指数大幅下降至32.45和24.47克·毫米²。讨论了低血容量（ Bainbridge反射）或丙泊酚拟迷走神经作用的影响。然而，本研究表明，输注丙泊酚比美索比妥能更好地实现充分麻醉。
