Dhadphale P R, Jackson A P, Alseri S
Anesthesiology. 1979 Sep;51(3):200-3. doi: 10.1097/00000542-197909000-00004.
Because of its analgesic and amnesic effects, ketamine has potential advantages as a primary agent for patients undergoing open-heart surgery. However, the undesirable positive inotropic and chronotropic effects associated with ketamine have deterred its use. Diazepam pretreatment appears to block these unwanted effects. Sixteen randomly selected patients were given a combination of diazepam, 0.4 mg/kg, followed by ketamine, 2 mg/kg, and nitrous oxide, 50%. The authors compared the circulatory responses to induction, intubation, and operation with those obtained in a matched group of patients who received morphine, 3 mg/kg, and nitrous oxide, 50%. All patients underwent mitral- or aortic-valve replacement. Circulatory responses were not significantly different between the two groups. In both groups, heart rate, mean arterial blood pressure, and rate-pressure product increased significantly with intubation of the trachea, incision of the skin, and sternotomy. The incidences of hypertension, hypotension, and arrhythmias, and the need for inotropic drugs were not significantly different between the two groups. No intraoperative awareness occurred in either group. It is concluded that diazepam-ketamine anesthesia is a satisfactory alternative to morphine anesthesia for patient undergoing heart-valve replacement.
由于氯胺酮具有镇痛和遗忘作用，它作为心脏直视手术患者的主要麻醉剂具有潜在优势。然而，氯胺酮相关的不良正性肌力和变时性作用阻碍了其应用。地西泮预处理似乎可以阻断这些不良作用。随机选择16例患者，先给予0.4mg/kg的地西泮，随后给予2mg/kg的氯胺酮和50%的氧化亚氮。作者将诱导、插管和手术过程中的循环反应与一组接受3mg/kg吗啡和50%氧化亚氮的匹配患者的反应进行了比较。所有患者均接受二尖瓣或主动脉瓣置换术。两组间的循环反应无显著差异。在两组中，气管插管、皮肤切开和胸骨切开时心率、平均动脉血压和心率-血压乘积均显著升高。两组间高血压、低血压和心律失常的发生率以及使用正性肌力药物的需求无显著差异。两组均未发生术中知晓。结论是，对于接受心脏瓣膜置换术的患者，地西泮-氯胺酮麻醉是吗啡麻醉的一种令人满意的替代方法。
