Bennett J A, Mahadeviah A, Stewart J, Lingaraju N, Keykhah M M
Department of Anesthesiology, Medical College of Pennsylvania, Philadelphia, USA.
J Clin Anesth. 1995 Jun;7(4):288-91. doi: 10.1016/0952-8180(95)00029-h.
To compare the control of hemodynamic response to surgical stimulus of desflurane to that of isoflurane.
Prospective randomized study.
Operating room of a major U.S. teaching hospital.
59 ASA status I, II, and III patients 18 to 80 years of age and were undergoing orthopedic or intra-abdominal surgical procedures of 1 or more hours in duration.
Group 1 (n = 29) received desflurane in oxygen (O2) for their surgical procedure. Group 2 (n = 30) received isoflurane in O2 for their surgical procedure. Thiopental sodium 4 mg/kg and fentanyl 3 micrograms/kg provided induction; vecuronium 0.1 mg/kg facilitated intubation. Prior to incision the volatile anesthesia drug was titrated to maintain systolic blood pressure (SBP) within 20% of preinduction (baseline) values. Any time after incision, an SBP increase greater than 20% of baseline was treated with a 30% increase in inspired anesthetic concentration for 3 minutes, or until SBP was within 10% of baseline. Another three 30% increases were allowed at 3 minute intervals to return SBP to 10% of baseline. If four 30% increases did not return SBP to 10% of baseline, additional fentanyl up to 5 micrograms/kg or labetalol in 5 mg increments was given.
Measurement of hemodynamics and anesthetic concentration occurred every 2 minutes prior to skin incision and every 5 minutes thereafter. Measurement of hemodynamics and anesthetic concentration occurred every minute during treatment of blood pressure (BP) response to surgical stimulus. Desflurane allowed for more rapid control of BP response to surgical stimulus median 2 minutes (range 1 to 12 minutes) for desflurane versus 6 minutes (range 1 to 12 minutes, p = 0.011). The desflurane group required fewer 30% incremental anesthetic increases than the isoflurane group (1.8 versus 2.5, p = 0.016) to control increased SBP. End tidal/inspired drug concentration ratios were closer to unity in the desflurane patients both before (0.94 versus 0.80) and after (0.86 versus 0.70) changes in drug concentration to treat increased SBP.
Anesthetic depth can be more rapidly titrated with desflurane compared to isoflurane. Alveolar/inspired concentration ratio approaches unity more rapidly with desflurane anesthesia.
比较地氟烷与异氟烷对手术刺激的血流动力学反应控制情况。
前瞻性随机研究。
美国一家大型教学医院的手术室。
59例年龄在18至80岁之间、ASA分级为I、II和III级的患者，正在接受时长1小时或更长时间的骨科或腹部内外科手术。
第1组（n = 29）在手术过程中接受氧气（O2）与地氟烷混合麻醉。第2组（n = 30）在手术过程中接受氧气与异氟烷混合麻醉。硫喷妥钠4mg/kg和芬太尼3μg/kg用于诱导麻醉；维库溴铵0.1mg/kg辅助插管。在切口前，滴定挥发性麻醉药物以维持收缩压（SBP）在诱导前（基线）值的20%以内。切口后任何时候，若SBP升高超过基线的20%，则将吸入麻醉浓度提高30%，持续3分钟，或直至SBP在基线的10%以内。允许每隔3分钟再进行三次30%的浓度增加，以使SBP恢复至基线的10%。如果四次30%的浓度增加未能使SBP恢复至基线的10%，则给予额外的芬太尼，剂量最高可达5μg/kg，或每次递增5mg的拉贝洛尔。
在皮肤切口前每2分钟、切口后每5分钟测量血流动力学和麻醉浓度。在处理对手术刺激的血压（BP）反应期间，每分钟测量血流动力学和麻醉浓度。地氟烷能更快速地控制对手术刺激的血压反应，地氟烷组的中位数为2分钟（范围1至12分钟），而异氟烷组为6分钟（范围1至12分钟，p = 0.011）。地氟烷组在控制升高的SBP时，所需的30%麻醉浓度增加次数少于异氟烷组（1.8次对2.5次，p = 0.016）。在处理升高的SBP而改变药物浓度之前（0.94对0.80）和之后（0.86对0.70），地氟烷组患者的呼气末/吸入药物浓度比更接近1。
与异氟烷相比，地氟烷可更快速地滴定麻醉深度。地氟烷麻醉时，肺泡/吸入浓度比更快接近1。
