Mustola S T, Baer G A, Metsä-Ketelä T, Laippala P
Department of Anaesthesia, South Carelian Central Hospital, Lappeenranta, Finland.
Anaesthesia. 1995 Feb;50(2):108-13. doi: 10.1111/j.1365-2044.1995.tb15090.x.
We compared the haemodynamic responses to endolaryngeal procedures during anaesthesia with propofol or thiopentone. Two minutes after administration of glycopyrronium 4 micrograms.kg-1 and alfentanil 17.5 micrograms.kg-1 anaesthesia was induced with either propofol 2.0 mg.kg-1 (n = 8) or thiopentone 5.0 mg.kg-1.min-1, respectively. Muscle relaxation was induced and maintained with suxamethonium. Intratracheal jet-ventilation (rate: 20 breath.min-1) was with 100% oxygen. Blood samples for later determination of plasma catecholamines were drawn and haemodynamic responses were recorded at tracheal intubation, after insertion of the operating laryngoscope, during the endolaryngeal procedure and after extubation. With both anaesthetic agents the only statistically significant haemodynamic response to intubation was a rise of heart rate. With propofol, plasma adrenaline concentrations decreased significantly after induction and remained below baseline values throughout the procedure. After insertion of the operating laryngoscope the haemodynamic response was more pronounced with thiopentone than with propofol. Propofol blocks the catecholamine and haemodynamic responses to endolaryngeal procedures more effectively than thiopentone.
我们比较了在丙泊酚或硫喷妥钠麻醉期间，喉部手术的血流动力学反应。给予4微克·千克⁻¹格隆溴铵和17.5微克·千克⁻¹阿芬太尼两分钟后，分别用2.0毫克·千克⁻¹丙泊酚（n = 8）或5.0毫克·千克⁻¹·分钟⁻¹硫喷妥钠诱导麻醉。用琥珀胆碱诱导并维持肌肉松弛。气管内喷射通气（频率：20次呼吸·分钟⁻¹）采用100%氧气。在气管插管时、插入手术喉镜后、喉部手术期间及拔管后采集血样用于后续血浆儿茶酚胺的测定，并记录血流动力学反应。两种麻醉剂对插管唯一有统计学意义的血流动力学反应是心率升高。使用丙泊酚时，诱导后血浆肾上腺素浓度显著降低，并在整个手术过程中保持低于基线值。插入手术喉镜后，硫喷妥钠引起的血流动力学反应比丙泊酚更明显。丙泊酚比硫喷妥钠更有效地阻断喉部手术的儿茶酚胺和血流动力学反应。
