Castor G, Altmayer P, Venitz J
Klinik für Anästhesiologie und Intensivmedizin, Caritas Krankenhauses Dillingen/Saar.
Anaesthesiol Reanim. 1995;20(4):97-100.
In the present study the disposition of alfentanil after cessation of a constant rate infusion was compared with intravenous bolus injections. In 11 patients undergoing intervertebral disk surgery general anaesthesia was induced with midazolam, alfentanil and vecuronium; anaesthesia was maintained with a constant rate infusion (1.5 to 2 micrograms/kg/min, 1.0 micrograms/kg/min at the end of the infusion period) of alfentanil. The parameters of bolus injections were obtained from 5 patients undergoing lithotripter therapy; an intravenous bolus of 15 micrograms/kg was given. After infusion times of 60 to 120 minutes the mean elimination half life of alfentanil was significantly increased (227 +/- 166 min) compared to the bolus injection (50.8 +/- 9.5 min). There were significant correlations of the elimination half life with the age (r = 0.53, p = 0.03) of the patients, the total dose (r = 0.607, p = 0.01) and the infusion time (r = 0.612, p = 0.01). The total clearance of alfentanil in the bolus group was 385 +/- 138 ml/min and in the infusion group 620 +/- 215 ml/min. There were no significant correlations between the total clearance of alfentanil and the total dose and between the duration of infusion and total clearance. The clinical implications of our study: After prolonged continuous infusions of alfentanil a significant reduction of the elimination rate has to be considered. The patients must be observed very carefully in the recovery room in order to prevent a possible respiratory depression.
在本研究中，将持续输注停止后阿芬太尼的处置情况与静脉推注进行了比较。11例接受椎间盘手术的患者，用咪达唑仑、阿芬太尼和维库溴铵诱导全身麻醉；用阿芬太尼持续输注（1.5至2微克/千克/分钟，输注期结束时为1.0微克/千克/分钟）维持麻醉。推注的参数来自5例接受碎石治疗的患者；静脉推注15微克/千克。输注60至120分钟后，阿芬太尼的平均消除半衰期与推注相比显著延长（227±166分钟 vs 50.8±9.5分钟）。消除半衰期与患者年龄（r = 0.53，p = 0.03）、总剂量（r = 0.607，p = 0.01）和输注时间（r = 0.612，p = 0.01）之间存在显著相关性。推注组阿芬太尼的总清除率为385±138毫升/分钟，输注组为620±215毫升/分钟。阿芬太尼的总清除率与总剂量之间以及输注持续时间与总清除率之间均无显著相关性。我们研究的临床意义：长时间持续输注阿芬太尼后，必须考虑消除率的显著降低。在恢复室必须非常仔细地观察患者，以防止可能的呼吸抑制。
