Hickey P R, Hansen D D
Anesth Analg. 1984 Feb;63(2):117-24.
The safety and efficacy of fentanyl-oxygen (50 and 75 micrograms/kg) and sufentanil-oxygen (5 and 10 micrograms/kg) were studied in 40 infants undergoing repair of complex heart defects. When fentanyl or sufentanil was given simultaneously with pancuronium, induction of anesthesia was rapid and smooth with only mild and clinically insignificant hemodynamic changes. Hemodynamic responses to tracheal intubation were completely blocked, whereas hemodynamic responses to surgical incision and sternotomy were partially and variably blocked. Except for somewhat more effective blocking of responses to surgical stimulation by sufentanil, the effects of both narcotics were similar. No significant differences in effects were found between the two dose levels of either drug. Transcutaneous oxygen tensions increased with induction, intubation, and surgical stimulation with both fentanyl and sufentanil, even in cyanotic patients with right to left shunts. Fentanyl- and sufentanil-oxygen-pancuronium anesthesia were both safe and effective for cardiac surgery in infants. This study raises the question of possible beneficial effects of high dose fentanyl and sufentanil in blunting stress responses in the pulmonary circulation, a critical aspect of anesthesia and intensive care in the infant and neonate.
在40例接受复杂心脏缺陷修复手术的婴儿中，研究了芬太尼-氧气（50和75微克/千克）和舒芬太尼-氧气（5和10微克/千克）的安全性和有效性。当芬太尼或舒芬太尼与潘库溴铵同时给药时，麻醉诱导迅速且平稳，仅伴有轻微且临床上无显著意义的血流动力学变化。对气管插管的血流动力学反应被完全阻断，而对手术切口和胸骨切开术的血流动力学反应被部分且不同程度地阻断。除了舒芬太尼对手术刺激反应的阻断效果稍好外，两种麻醉剂的效果相似。两种药物的两个剂量水平之间在效果上未发现显著差异。即使在有右向左分流的青紫型患者中，经皮氧分压在芬太尼和舒芬太尼诱导、插管及手术刺激时均升高。芬太尼-氧气-潘库溴铵麻醉和舒芬太尼-氧气-潘库溴铵麻醉对婴儿心脏手术均安全有效。本研究提出了高剂量芬太尼和舒芬太尼在减轻肺循环应激反应方面可能具有有益作用的问题，这是婴儿和新生儿麻醉及重症监护的一个关键方面。
