Nishina K, Mikawa K, Maekawa N, Obara H
Department of Anaesthesiology, Kobe University School of Medicine, Japan.
Anesth Analg. 1995 Jun;80(6):1217-22. doi: 10.1097/00000539-199506000-00026.
We conducted a randomized, double-blind study to examine the effects of intravenous (i.v.) diltiazem (0.1 or 0.2 mg/kg) on hemodynamic changes during tracheal extubation and emergence from anesthesia in 80 ASA physical status I patients undergoing elective gynecologic surgery. The effect of diltiazem was compared with that of lidocaine or saline. Anesthesia was maintained with 0.5%-1.5% isoflurane and 60% nitrous oxide (N2O) in oxygen. Muscle relaxation was achieved with vecuronium. The patients were randomly assigned to one of four groups (n = 20 for each group): saline (as a control), 0.1 mg/kg diltiazem, 0.2 mg/kg diltiazem, and 1 mg/kg lidocaine. These medications were given 2 min before tracheal extubation. Changes in heart rate (HR) and blood pressure (BP) were measured during and after tracheal extubation. The HR, systolic BP, and diastolic BP increased significantly during tracheal extubation in the control group (P < 0.05). Diltiazem, 0.1 and 0.2 mg/kg, and lidocaine attenuated the increases in these variables. The inhibitory effect on these cardiovascular responses was greatest with diltiazem 0.2 mg/kg, while the extent of attenuation by diltiazem 0.1 mg/kg was similar to that by lidocaine. We concluded that a bolus dose of i.v. diltiazem 0.1 or 0.2 mg/kg given 2 min before extubation was of value in attenuating the cardiovascular changes occurring in association with tracheal extubation and emergence from anesthesia. This alleviative effect of diltiazem was equal or superior to that of i.v. lidocaine 1 mg/kg.
我们进行了一项随机、双盲研究，以探讨静脉注射地尔硫䓬（0.1或0.2mg/kg）对80例接受择期妇科手术的ASA身体状况I级患者气管拔管和麻醉苏醒期间血流动力学变化的影响。将地尔硫䓬的效果与利多卡因或生理盐水的效果进行比较。麻醉维持采用0.5%-1.5%异氟醚和60%氧化亚氮（N2O）混合氧气。使用维库溴铵实现肌肉松弛。患者被随机分为四组（每组n = 20）：生理盐水（作为对照）、0.1mg/kg地尔硫䓬、0.2mg/kg地尔硫䓬和1mg/kg利多卡因。这些药物在气管拔管前2分钟给予。在气管拔管期间及之后测量心率（HR）和血压（BP）的变化。对照组在气管拔管期间HR、收缩压和舒张压显著升高（P < 0.05）。0.1mg/kg和0.2mg/kg的地尔硫䓬以及利多卡因减轻了这些变量的升高。0.2mg/kg地尔硫䓬对这些心血管反应的抑制作用最大，而0.1mg/kg地尔硫䓬的衰减程度与利多卡因相似。我们得出结论，拔管前2分钟静脉推注0.1或0.2mg/kg地尔硫䓬对于减轻与气管拔管和麻醉苏醒相关的心血管变化具有价值。地尔硫䓬的这种缓解作用等同于或优于1mg/kg静脉注射利多卡因。
