七氟醚在婴幼儿中的药理学。

The pharmacology of sevoflurane in infants and children.

作者信息

Lerman J, Sikich N, Kleinman S, Yentis S

机构信息

Department of Anaesthesia, Hospital for Sick Children, University of Toronto Ontario, Canada.

出版信息

Anesthesiology. 1994 Apr;80(4):814-24. doi: 10.1097/00000542-199404000-00014.

DOI:10.1097/00000542-199404000-00014

PMID:8024136

Abstract

BACKGROUND

Sevoflurane is a new volatile anesthetic with physical properties that should make it suitable for anesthesia (MAC of sevoflurane on oxygen alone and in 60% nitrous oxide, (MAC) of sevoflurane in oxygen alone and in 60% nitrous oxide, the hemodynamic, induction and emergence responses to sevoflurane and the metabolism to inorganic fluoride were studied in 90 ASA physical status 1 or 2 neonates, infants, and children.

METHODS

MAC of sevoflurane in oxygen was determined in six groups of subjects stratified according to age: full-term neonates, infants 1-6 and > 6-12 months and children > 1-3, > 3-5 and > 5-12 yr. MAC in 60% nitrous oxide was determined in a separate group of children 1-3 yr of age. After an inhalational induction, the trachea was intubated (except for neonates in whom an awake intubation was performed). MAC for each age group was determined using the Up-and-Down technique of Dixon.

RESULTS

MAC of sevoflurane in neonates, 3.3 +/- 0.2% and in infants 1-6 months of age, 3.2 +/- 0.1%, were similar; MAC in older infants 6-12 months and children 1-12 yr was constant at approximately 2.5%; MAC of sevoflurane in 60% nitrous oxide in children 1-3 yr of age was 2.0 +/- 0.2%. Systolic arterial pressure decreased significantly at 1 MAC before skin incision compared with awake values in all subjects except children 1-3 yr with 60% nitrous oxide and children 5-12 yr in oxygen, and then returned toward awake values after skin incision. Heart rate was unchanged at approximately 1 MAC sevoflurane before incision compared with awake values in all subjects except children > 3-5 and > 5-12 yr in whom heart rate increased before incision. Induction of anesthesia, particularly with respect to airway irritability, and emergence from sevoflurane anesthesia were not remarkable. The plasma concentration of inorganic fluoride reached maximum values (8.8-16.7 microM) 30 min after discontinuation of anesthesia.

CONCLUSIONS

We conclude that sevoflurane appears to be a suitable anesthetic agent for use in neonates, infants and children undergoing < or = 1 h of anesthesia.

摘要

背景

七氟烷是一种新型挥发性麻醉剂，其物理性质使其适用于麻醉。在90例美国麻醉医师协会（ASA）身体状况为1或2级的新生儿、婴儿和儿童中，研究了七氟烷在纯氧中以及在60%氧化亚氮中的最低肺泡有效浓度（MAC）、七氟烷的血流动力学、诱导和苏醒反应以及其向无机氟的代谢情况。

方法

根据年龄将六组受试者分为：足月儿、1 - 6个月及大于6 - 12个月的婴儿以及大于1 - 3岁、大于3 - 5岁和大于5 - 12岁的儿童，测定七氟烷在氧气中的MAC。在另一组1 - 3岁的儿童中测定七氟烷在60%氧化亚氮中的MAC。吸入诱导后进行气管插管（新生儿除外，其进行清醒插管）。使用Dixon的上下法确定每个年龄组的MAC。

结果

新生儿七氟烷的MAC为3.3±0.2%，1 - 6个月婴儿的MAC为3.2±0.1%，二者相似；6 - 12个月的较大婴儿和1 - 12岁儿童的MAC恒定在约2.5%；1 - 3岁儿童七氟烷在60%氧化亚氮中的MAC为2.0±0.2%。与清醒值相比，除了吸入60%氧化亚氮的1 - 3岁儿童和吸入纯氧的5 - 12岁儿童外，所有受试者在皮肤切开前1MAC时收缩动脉压均显著下降，然后在皮肤切开后恢复至清醒值。与清醒值相比，除了大于3 - 5岁和大于5 - 12岁的儿童在切开前心率增加外，所有受试者在切开前七氟烷约1MAC时心率无变化。七氟烷麻醉的诱导，特别是在气道刺激性方面，以及苏醒情况均无明显异常。麻醉停止后30分钟，无机氟的血浆浓度达到最大值（8.8 - 16.7微摩尔）。