Tammisto T, Aromaa U, Korttila K
Acta Anaesthesiol Scand. 1980;24(1):31-5. doi: 10.1111/j.1399-6576.1980.tb01500.x.
In order to clarify the interactions between various doses of thiopental and fentanyl in producing "balanced anaesthesia", their effects on consciousness, superficial nociception, and respiration and circulation were studied during N2O+O2 inhalation in connection with the induction of anaesthesia. Altogether 60 patients were studied; the drug combinations used were thiopental 5 mg/kg (TP5), thipental 3 mg/kg (TP3), thiopental 3 mg/kg and fentanyl 0.5 micrograms/kg (TP3F0.5), thiopental 2 mg/kg and fentanyl 1 micrograms/kg (TP2F1), thiopental 1 mg/kg and fentanyl 2 micrograms/kg (TP1F2), and fentanyl 3 micrograms/kg (F3). Five minutes after the i.v. supplementation of N2O+O2 anaesthesia, the depth of anaesthesia and analgesia (antinociception) were evaluated from the eyelid reflex and by pinching an inguinal skin fold. Cardiorespiratory parameters were measured during this study period at 1-min intervals. The balance between antinociception and anaesthesia was closest to optimum in groups TP2F1 and TP2F0.5. In pure thiopental groups, the analgesia was poor; only four patients did not respond to the nociceptive stimulus, whereas in group F3 anaesthesia (disappearance of the eyelid reflex) was obtained in only two patients. The respiratory depression was most pronounced in groups receiving 3, 2 and 1 micrograms/kg fentanyl and weakest in groups where only thiopental was used. Blood pressure decreased in all groups but no statistically significant differences were noted. On the basis of the results it seems obvious that attempts to achieve what is called "balanced anaesthesia" by the supplementation of an N2O+O2 mixture with fentanyl only leads to an unnecessarily prnounced respiratory depression, whereas supplementation with thiopental alone does not offer adequate antinociception.
为阐明不同剂量硫喷妥钠与芬太尼在产生“平衡麻醉”时的相互作用，在吸入N₂O + O₂诱导麻醉过程中，研究了它们对意识、浅部痛觉以及呼吸和循环的影响。共研究了60例患者；所用药物组合为硫喷妥钠5mg/kg（TP5）、硫喷妥钠3mg/kg（TP3）、硫喷妥钠3mg/kg加芬太尼0.5μg/kg（TP3F0.5）、硫喷妥钠2mg/kg加芬太尼1μg/kg（TP2F1）、硫喷妥钠1mg/kg加芬太尼2μg/kg（TP1F2）以及芬太尼3μg/kg（F3）。静脉补充N₂O + O₂麻醉5分钟后，通过眼睑反射和捏腹股沟皮肤皱襞评估麻醉深度和镇痛（抗伤害感受）效果。在本研究期间，每隔1分钟测量一次心肺参数。TP2F1组和TP2F0.5组的抗伤害感受与麻醉之间的平衡最接近最佳状态。在单纯硫喷妥钠组中，镇痛效果较差；只有4例患者对伤害性刺激无反应，而在F3组中，仅2例患者出现麻醉（眼睑反射消失）。接受3μg/kg、2μg/kg和1μg/kg芬太尼的组呼吸抑制最明显，仅使用硫喷妥钠的组呼吸抑制最弱。所有组血压均下降，但未观察到统计学上的显著差异。基于这些结果，很明显，仅通过向N₂O + O₂混合物中添加芬太尼来实现所谓的“平衡麻醉”只会导致不必要的明显呼吸抑制，而单独使用硫喷妥钠则不能提供足够的抗伤害感受。
