Seeling W, Ahnefeld F W, Rosenberg G, Heinrich H, Spilker D
Anaesthesist. 1985 May;34(5):217-28.
In 50 patients scheduled for infrarenal aortic bypass surgery the cardiovascular effects of two anaesthetic regimes were investigated prior to surgery. A Swan-Ganz-catheter was used for haemodynamic measurements. These patients, having been randomized into two groups, were optimally volume loaded (PCWP 10 mmHg) before anaesthesia. In 24 patients a thoracic epidural was induced with 12-15 ml 0.25% plain bupivacaine. When segmental anaesthesia had extended from T4/5 to L1/2 general anaesthesia was additionally applied (flunitrazepam 1.5-2 mg, pancuronium bromide 0.1 mg/kg). In 26 patients neuroleptanaesthesia was induced (droperidol 0.1-0.2 mg/kg, fentanyl 0.01 mg/kg, pancuronium bromide 0.1 mg/kg, and thiopentone 100-150 mg. Haemodynamic measurements were made before injection into the epidural catheter, after complete spread of anaesthesia, before commencing general anaesthesia and 10-15 min thereafter.
Neither of the two procedures were associated with severe haemodynamic alterations. In the epidural group HR fell slightly during latency of complete spread and increased to the same extend following general anaesthesia. The epidural caused MAP (104 to 88 mmHg), mean PAP (20 to 14 mmHg), PCWP (10 to 7.5 mmHg), and RAP (4.5 to 2.5 mmHg) to decrease moderately but no further changes were effected by the subsequent general anaesthesia. SVR and PVR were not influenced by either epidural or by general anaesthesia. CI (3.6 to 3.41 . min-1 . m-2), LVSWI (67 to 52 p . m-1), and cardiac minute work index (55 to 40 J . min-1 . m-2) decreased during latency of complete spread but were no further influenced by general anaesthesia. The haemodynamic changes of neuroleptanaesthesia were almost identical to those of the combined epidural-general anaesthesia. For the operation which followed, a continuous infusion of 0.125 per cent plain bupivacaine (0.25 ml/kg X h) via epidural catheter (in combination with N2O/O2-anaesthesia) was sufficient for complete analgesia in the epidural group. These findings lead to the conclusion that a small bolus volume and a low concentration of bupivacaine result in good anaesthesia while avoiding serious haemodynamic alterations.
在50例计划进行肾下主动脉搭桥手术的患者中，术前研究了两种麻醉方案对心血管系统的影响。使用Swan-Ganz导管进行血流动力学测量。这些患者被随机分为两组，在麻醉前进行了最佳容量负荷（肺毛细血管楔压10 mmHg）。24例患者采用12 - 15 ml 0.25%的布比卡因原液诱导胸段硬膜外麻醉。当节段性麻醉从T4/5扩展到L1/2时，额外给予全身麻醉（氟硝西泮1.5 - 2 mg，泮库溴铵0.1 mg/kg）。26例患者诱导神经安定麻醉（氟哌利多0.1 - 0.2 mg/kg，芬太尼0.01 mg/kg，泮库溴铵0.1 mg/kg，硫喷妥钠100 - 150 mg）。在向硬膜外导管注射药物前、麻醉完全扩散后、开始全身麻醉前及此后10 - 15分钟进行血流动力学测量。
两种方法均未引起严重的血流动力学改变。在硬膜外组，心率在麻醉完全扩散的潜伏期略有下降，全身麻醉后以相同幅度上升。硬膜外麻醉使平均动脉压（从104降至88 mmHg）、平均肺动脉压（从20降至14 mmHg）、肺毛细血管楔压（从10降至7.5 mmHg）和右房压（从4.5降至2.5 mmHg）适度下降，但随后的全身麻醉未产生进一步变化。全身血管阻力和肺血管阻力均未受硬膜外麻醉或全身麻醉的影响。心脏指数（从3.6降至3.4 l·min-1·m-2）、左室每搏功指数（从67降至52 g·m-1）和心脏每分钟作功指数（从55降至40 J·min-1·m-2）在麻醉完全扩散的潜伏期下降，但未进一步受全身麻醉影响。神经安定麻醉的血流动力学变化与硬膜外 - 全身联合麻醉几乎相同。对于随后的手术，通过硬膜外导管持续输注0.125%的布比卡因原液（0.25 ml/kg·h）（联合N2O/O2麻醉）对硬膜外组足以实现完全镇痛。这些发现得出结论，小剂量推注和低浓度布比卡因可产生良好麻醉效果，同时避免严重的血流动力学改变。
