Kling D, Bachmann B, Moosdorf R, Hempelmann G
Abteilung Anaesthesiologie und operative Intensivmedizin, Klinikum der Justus-Liebig-Universität Giessen.
Anaesthesist. 1987 Nov;36(11):640-5.
Propofol, a rapid and short-acting i.v. anesthetic, was associated with the risk of anaphylactic reactions in its original cremophor-EL formulation. It has been reformulated in a soybean emulsion with satisfactory anesthetic properties. A former study of hemodynamic changes after i.v. induction with propofol, thiopental, methohexital, etomidate, and midazolam in patients with coronary artery disease demonstrated that in comparison to other induction agents propofol depressed systolic and diastolic arterial pressures more severely, compromising coronary perfusion. In the present investigation left ventricular parameters as well as hemodynamic effects during extracorporeal circulation (ECC) were studied in comparison to midazolam during opiate analgesia. Methods. Hemodynamic effects of 2 mg/kg body weight propofol as compared to 0.15 mg/kg midazolam were studied in 34 patients during coronary artery surgery before cannulation of the large vessels (measurement of left ventricular parameters) or during ECC (measurement of arterial perfusion pressure and oxygenator volume). Results (see Table 1, Figs. 1 and 2). Propofol decreased systolic and diastolic pressures (-27%, -22%) more than midazolam (-10%, -9%). Cardiac index and stroke volume index were diminished following both drugs (propofol: -14%, -9%; midazolam: -15%, -11%); total systemic resistance was reduced significantly by propofol (-22%). Dp/dtmax was compromised more markedly by propofol (-24%) than by midazolam (-18%), but there was no significant difference.(ABSTRACT TRUNCATED AT 250 WORDS)
丙泊酚是一种起效迅速、作用时间短暂的静脉麻醉药，其最初的聚氧乙烯蓖麻油制剂存在过敏反应风险。现在它已被重新制成具有良好麻醉特性的大豆乳剂。之前一项关于冠心病患者静脉注射丙泊酚、硫喷妥钠、美索比妥、依托咪酯和咪达唑仑后血流动力学变化的研究表明，与其他诱导药物相比，丙泊酚更严重地降低收缩压和舒张压，损害冠状动脉灌注。在本研究中，与阿片类镇痛药镇痛期间的咪达唑仑相比，研究了体外循环（ECC）期间的左心室参数以及血流动力学效应。方法：在34例冠状动脉手术患者中，于大血管插管前（测量左心室参数）或体外循环期间（测量动脉灌注压和氧合器容量），研究了2mg/kg体重丙泊酚与0.15mg/kg咪达唑仑的血流动力学效应。结果（见表1、图1和图2）。丙泊酚降低收缩压和舒张压（-27%，-22%）的幅度大于咪达唑仑（-10%，-9%）。两种药物使用后心脏指数和每搏量指数均降低（丙泊酚：-14%，-9%；咪达唑仑：-15%，-11%）；丙泊酚使总体循环阻力显著降低（-22%）。丙泊酚对dp/dtmax的影响（-24%）比咪达唑仑（-18%）更明显，但差异无统计学意义。（摘要截短至250字）
