Stefánsson T, Wickström I, Haljamäe H
Acta Anaesthesiol Scand. 1982 Aug;26(4):371-7. doi: 10.1111/j.1399-6576.1982.tb01785.x.
The cardiovascular and metabolic effects of ketamine as the sole anesthetic agent for surgical correction of fractured neck of femur were studied in eight spontaneously breathing geriatric patients (mean age 83 years) before premedication, at the end of operation, and 15 min and 2 h after the end of anesthesia. Arterial blood pressure, cardiac index, left ventricular stroke work index and oxygen consumption increased during anesthesia but had returned to preoperative levels 15 min after the end of anesthesia. Vascular resistance, heart rate and stroke volume index were not significantly changed. During anesthesia, arterial carbon dioxide tension increased whereas arterial pH and arterial BE decreased. The levels of glucose and lactate increased in both blood and skeletal muscle during anesthesia and remained elevated throughout the period studied but the lactate:pyruvate ratio was unchanged. High energy phosphagen levels in skeletal muscle did not change. Ketamine anesthesia in the spontaneously breathing geriatric patient induces cardiovascular stimulation and metabolic changes indicative of an increased sympathetic stimulation, whereas respiration is slightly depressed. The magnitude of these changes is, however, small and it thus seems that ketamine can be safely used as the sole anesthetic agent for hip fracture surgery in the average geriatric patient.
在八名自主呼吸的老年患者（平均年龄83岁）中，研究了氯胺酮作为股骨颈骨折手术矫正的唯一麻醉剂的心血管和代谢效应，观察时间点为术前用药前、手术结束时、麻醉结束后15分钟和2小时。麻醉期间动脉血压、心脏指数、左心室每搏功指数和氧耗增加，但在麻醉结束后15分钟恢复到术前水平。血管阻力、心率和每搏量指数无显著变化。麻醉期间，动脉二氧化碳分压升高，而动脉pH值和动脉碱剩余降低。麻醉期间血液和骨骼肌中的葡萄糖和乳酸水平均升高，并且在整个研究期间一直保持升高，但乳酸与丙酮酸的比值未改变。骨骼肌中的高能磷酸肌酸水平未变化。自主呼吸的老年患者使用氯胺酮麻醉会引起心血管刺激和代谢变化，提示交感神经刺激增加，而呼吸略有抑制。然而，这些变化的幅度较小，因此似乎氯胺酮可以安全地用作普通老年患者髋部骨折手术的唯一麻醉剂。
