Tammisto T, Tigerstedt I
Acta Anaesthesiol Scand. 1977;21(1):17-23. doi: 10.1111/j.1399-6576.1977.tb01187.x.
The demand for intermittant halothane supplementation during N2O-O2-relaxant anaesthesia was studied in 25 alcohlics (annual consumption over 15 1 pure alcohol) scheduled for biliary or gastric surgery. The controls were 45 non-alcoholics and 43 patients with an annual consumption of between 1 to 15 1. Thiopental (3 mg/kg/min) was given for induction. After intubation, halothane supplementation was given in 0.5% concentration for 10-min periods. Standardized criteria for halothane supplementation were various motor and autonomic responses to painful stimuli. Muscular relaxation was kept fairly constant (roughly 90%), as assessed visually with the aid of a peripheral nerve stimulator. The total time for which halothane supplementation was given, expressed as a percentage of the total anaesthesia time, was used as an indication of the need for halothane supplementation. The need for thiopental for induction was not increased to a statistically significant extent in alcoholics, but signs of excitation did occur in 40% as compared with 11% in non-alcoholics (P less than 0.01). The demand for halothane supplementation was higher in alcoholics (47 +/- 4.8%, s.e. mean) than in non-alcoholics (33 +/- 2.3%). This difference, however, was partly due to the higher incidence of gastric surgery, which required more supplementation than biliary surgery. Analysis of the different criteria indicating the need for halothane supplementation revealed that an increase in blood pressure or heart rate was more common in non-alcoholics, whereas motor irritability, sweating and lacrimation were more frequent in alcoholics. Management of the anaesthetic posed no special difficulties in the alcoholics with an estimated mean annual consumption of 32 +/- 4 (s.e. mean) litres of absolute alcohol. Three patients (5% of the alcohol consumers) reported dreams or recollections, suggesting that this mode of halothane supplementation does not guarantee an adequate anaesthetic depth. The difficulties and biases associated with this type of analysis are discussed.
对25例计划进行胆道或胃部手术的酗酒者（年纯酒精摄入量超过15升）在N₂O - O₂ - 肌松药麻醉期间间歇性补充氟烷的需求进行了研究。对照组为45例非酗酒者和43例年酒精摄入量在1至15升之间的患者。诱导时给予硫喷妥钠（3毫克/千克/分钟）。插管后，以0.5%的浓度给予氟烷补充，每次10分钟。补充氟烷的标准化标准是对疼痛刺激的各种运动和自主反应。借助外周神经刺激器进行视觉评估，肌肉松弛程度保持相当恒定（约90%）。补充氟烷的总时间占总麻醉时间的百分比被用作补充氟烷需求的指标。酗酒者诱导时硫喷妥钠的需求量没有增加到具有统计学意义的程度，但40%的酗酒者出现兴奋迹象，而非酗酒者为11%（P小于0.01）。酗酒者对氟烷补充的需求高于非酗酒者（47±4.8%，标准误均值），而非酗酒者为（33±2.3%）。然而，这种差异部分归因于胃部手术的发生率较高，胃部手术比胆道手术需要更多的补充。对表明需要补充氟烷的不同标准进行分析发现，血压或心率升高在非酗酒者中更常见，而运动激惹、出汗和流泪在酗酒者中更频繁。对于估计平均年纯酒精摄入量为32±4（标准误均值）升的酗酒者，麻醉管理没有造成特殊困难。3例患者（占酗酒者的5%）报告有梦境或回忆，提示这种氟烷补充方式不能保证足够的麻醉深度。讨论了与这类分析相关的困难和偏差。
