Kestin I G, McCrirrick A B
Department of Anaesthesia, Derriford Hospital, Plymouth.
Anaesthesia. 1995 Jun;50(6):514-7. doi: 10.1111/j.1365-2044.1995.tb06042.x.
Ten patients undergoing arterial surgery in the leg received a combined general anaesthetic, which included muscle relaxation and intubation of the trachea, and a regional anaesthetic using a lumbar extradural catheter. The radial arterial pressure was measured. Adrenaline 0.1 micrograms.kg-1 was administered intravenously and the heart rate, arterial pressure and oxygen saturation were recorded every 15 s for 10 min. Adrenaline in 5 ml of saline was given into the trachea at 10 min intervals. The first was saline only, and successive injections contained 0.5 micrograms.kg-1, 1 microgram.kg-1, 2 micrograms.kg-1, and 3 micrograms.kg-1 of adrenaline. The mean maximum rise in systolic arterial pressure after adrenaline given intravenously was 30 (SD 11) mmHg, and 15 (SD 16) mmHg after the maximum dose of adrenaline given into the trachea (p < 0.05). The mean systolic arterial pressure was significantly increased between 45 s and 4.5 min after the adrenaline given intravenously, and 2 min after adrenaline given into the trachea. Of seven patients who received adrenaline 3 micrograms.kg-1 into the trachea, six had no noticeable effect and in the other patient, the increase in arterial pressure was less than 90% of the maximum rise after the adrenaline. We conclude that adrenaline given into the trachea is unreliable in humans with very large doses necessary in some patients to produce a clinically useful haemodynamic effect.
10例接受腿部动脉手术的患者接受了全身麻醉联合区域麻醉，全身麻醉包括肌肉松弛和气管插管，区域麻醉采用腰段硬膜外导管。测量桡动脉压。静脉注射肾上腺素0.1微克/千克，每15秒记录心率、动脉压和血氧饱和度，持续10分钟。每隔10分钟将5毫升盐水中的肾上腺素注入气管。第一次仅注入盐水，随后的注射中肾上腺素含量分别为0.5微克/千克、1微克/千克、2微克/千克和3微克/千克。静脉注射肾上腺素后，收缩压平均最大升高幅度为30（标准差11）毫米汞柱，气管内注入最大剂量肾上腺素后为15（标准差16）毫米汞柱（p<0.05）。静脉注射肾上腺素后45秒至4.5分钟以及气管内注入肾上腺素后2分钟，平均收缩压显著升高。7例气管内注入3微克/千克肾上腺素的患者中，6例无明显效果，另一例患者动脉压升高幅度小于肾上腺素注射后最大升高幅度的90%。我们得出结论，气管内注入肾上腺素在人体中不可靠，在一些患者中需要非常大的剂量才能产生临床上有用的血流动力学效应。
