McCammon R L, Hilgenberg J C, Stoelting R K
Anesth Analg. 1980 Jun;59(6):438-41.
Circulatory responses following intravenous diazepam (0.5 mg/kg) and the subsequent addition of 50% nitrous oxide were studied in 14 patients undergoing elective aortocoronary saphenous vein bypass operations. No patient was receiving propranolol. Preanesthetic medication was with morphine and scopolamine. Diazepam was continuously infused over a 10-minute period. At the conclusion of the infusion, systolic and mean arterial pressures were 13% lower than control awake values (p less than 0.05). Heart rate, cardiac output, right atrial pressure, pulmonary arterial pressure, pulmonary artery occluded pressure, and systemic and pulmonary vascular resistance were not changed. The subsequent addition of nitrous oxide resulted in no further statistically significant changes except for a 2.4 torr increase in right atrial pressure (p less than 0.05). In contrast, previous data collected from similar patients demonstrated significant reductions in blood pressure and cardiac output while systemic and pulmonary vascular resistance and pulmonary artery occluded pressure were increased when nitrous oxide was added following the administration of morphine (1 to 2 mg/kg). It is concluded that the observed minimal circulatory changes following diazepam administration and the subsequent addition of nitrous oxide make diazepam-nitrous oxide a valuable alternative to a morphine-nitrous oxide induction of anesthesia in patients with coronary artery disease.
对14例择期行主动脉冠状动脉大隐静脉搭桥手术的患者，研究了静脉注射地西泮（0.5mg/kg）及随后添加50%氧化亚氮后的循环反应。无患者正在接受普萘洛尔治疗。麻醉前用药为吗啡和东莨菪碱。地西泮在10分钟内持续输注。输注结束时，收缩压和平均动脉压比清醒时的对照值低13%（p<0.05）。心率、心输出量、右心房压、肺动脉压、肺动脉闭塞压以及体循环和肺循环血管阻力均未改变。随后添加氧化亚氮除使右心房压升高2.4托（p<0.05）外，未引起进一步的统计学显著变化。相比之下，先前从类似患者收集的数据显示，在给予吗啡（1至2mg/kg）后添加氧化亚氮时，血压和心输出量显著降低，而体循环和肺循环血管阻力以及肺动脉闭塞压升高。结论是，在给予地西泮及随后添加氧化亚氮后观察到循环变化极小，这使得地西泮-氧化亚氮成为冠心病患者麻醉诱导中吗啡-氧化亚氮的一种有价值的替代方法。
