Camu F, Heytens L, Claeys M A
Acta Anaesthesiol Belg. 1985 Mar;36(1):23-31.
In this study we attempted to determine whether ciramadol, a mixed opioid agonist-antagonist, would provide a satisfactory analgesic supplementation to an anesthetic technique for major surgery. Fourteen surgical patients received a balanced anesthesia technique with nitrous oxide, oxygen and muscle relaxants following thiopental induction. Incremental doses of ciramadol were administered as indicated by the somatic, hemodynamic or other sympathetic responses to anesthetic and surgical stimulations. The mean requirements of ciramadol during surgery were inferred from each patient's time-dose curve. The mean loading dose of ciramadol needed was 2.5 +/- 0.4 mg/kg and for maintenance of the analgesic effects, ciramadol had to be administered at a rate of 0.41 +/- 0.09 mg/kg.h. The important transformation rate (50.4%/h) was suggestive of an analgetic ceiling effect. Despite the very large amounts of ciramadol given, the hemodynamic responses to noxious stimuli were not fully suppressed with hypertensive episodes occurring during surgery. Recovery of spontaneous ventilation appeared promptly after completion of surgery and no evidence of respiratory depression was seen. Minute ventilation, respiratory rate and arterial PaCO2 remained within normal limits up to two hours after the end of anesthesia. No incidence of adverse psychotomimetic effects was observed.
在本研究中，我们试图确定环拉朵（一种混合阿片类激动剂 - 拮抗剂）是否能为大型手术的麻醉技术提供令人满意的镇痛补充。14名手术患者在硫喷妥钠诱导后接受了氧化亚氮、氧气和肌肉松弛剂的平衡麻醉技术。根据对麻醉和手术刺激的躯体、血流动力学或其他交感神经反应，给予递增剂量的环拉朵。手术期间环拉朵的平均需求量由每位患者的时间 - 剂量曲线推断得出。所需环拉朵的平均负荷剂量为2.5±0.4mg/kg，为维持镇痛效果，环拉朵必须以0.41±0.09mg/kg·h的速率给药。重要的转换率（50.4%/h）提示存在镇痛天花板效应。尽管给予了大量的环拉朵，但手术期间仍出现高血压发作，对有害刺激的血流动力学反应未得到充分抑制。术后自主通气迅速恢复，未观察到呼吸抑制的证据。麻醉结束后两小时内，分钟通气量、呼吸频率和动脉血二氧化碳分压均保持在正常范围内。未观察到不良拟精神作用的发生。
