Dunnihoo M, Wuest A, Meyer M, Robinson M
AANA J. 1994 Jun;62(3):261-6.
Total intravenous anesthesia (TIVA) can be an effective alternative to inhalational anesthesia. Various techniques of TIVA have been associated with significant cardiovascular alterations and prolonged wake up times. The purpose of this study was to determine if TIVA utilizing propofol, ketamine, and vecuronium would provide stable hemodynamics in normotensive ASA physical status I and II patients and allow rapid awakening upon completion of surgery. Anesthesia was induced with propofol 1.0 mg/kg intravenously (IV), followed immediately by ketamine 1.0 mg/kg IV and vecuronium 0.1 mg/kg IV. Anesthesia was maintained by constant infusion of propofol 100-200 micrograms/kg/min and ketamine 17-34 micrograms/kg/min. This combination maintained hemodynamic stability and provided a rapid wake up time in 80% of the 40 subjects. The remaining 20% experienced significant tachycardia and hypertension or premature ventricular contractions. The mean wake up time was 9.7 minutes from time of neuromuscular blocking reversal to time of extubation. TIVA can be accomplished with propofol, ketamine, and vecuronium; however, 20% of patients experienced side effects, which make this method less attractive compared to alternative anesthetic techniques.
全静脉麻醉（TIVA）可以作为吸入麻醉的一种有效替代方法。各种TIVA技术都与显著的心血管改变和苏醒时间延长有关。本研究的目的是确定使用丙泊酚、氯胺酮和维库溴铵的TIVA是否能在血压正常的美国麻醉医师协会（ASA）身体状况I级和II级患者中提供稳定的血流动力学，并在手术结束后实现快速苏醒。静脉注射1.0毫克/千克丙泊酚诱导麻醉，随后立即静脉注射1.0毫克/千克氯胺酮和0.1毫克/千克维库溴铵。通过持续输注100 - 200微克/千克/分钟的丙泊酚和17 - 34微克/千克/分钟的氯胺酮维持麻醉。这种联合用药在40名受试者中的80%维持了血流动力学稳定性并提供了快速苏醒时间。其余20%的受试者出现了显著的心动过速、高血压或室性早搏。从神经肌肉阻滞逆转到拔管的平均苏醒时间为9.7分钟。TIVA可以通过丙泊酚、氯胺酮和维库溴铵来完成；然而，20%的患者出现了副作用，这使得该方法与其他麻醉技术相比吸引力较小。
