Thrush D N, Steighner M L
Nurse Anesth. 1993 Dec;4(4):155-9.
Premedication of patients requiring cardiac surgery should provide adequate analgesia, sedation and anxiolysis for the stress and pain associated with preoperative preparation and placement of monitoring catheters. Ideally, these effects would be achieved without producing respiratory depression and hypoxia, which could be life-threatening to patients at risk for myocardial ischemia. Ketorolac, a nonsteroidal, antiinflammatory agent, has previously been shown to provide postoperative pain relief comparable to that provided by morphine, without respiratory depression. This study compared the incidence of arterial blood desaturation, respiratory depression, and patient comfort after preoperative medication with scopolamine and ketorolac versus scopolamine and morphine. Scopolamine and ketorolac premedication provided sedation and analgesia comparable to that provided by scopolamine and morphine, without significant respiratory depression. Since ketorolac has no central respiratory depressant effect, it may be a useful alternative to morphine for premedication in the cardiac surgical patient.
需要进行心脏手术的患者术前用药应能为与术前准备及放置监测导管相关的应激和疼痛提供充分的镇痛、镇静和抗焦虑作用。理想情况下,实现这些效果时不应产生呼吸抑制和低氧血症,因为这对有心肌缺血风险的患者可能会危及生命。酮咯酸是一种非甾体抗炎药,此前已证明它能提供与吗啡相当的术后疼痛缓解效果,且无呼吸抑制作用。本研究比较了术前使用东莨菪碱和酮咯酸与使用东莨菪碱和吗啡后动脉血氧饱和度降低、呼吸抑制及患者舒适度的发生率。术前使用东莨菪碱和酮咯酸提供的镇静和镇痛效果与使用东莨菪碱和吗啡相当,且无明显呼吸抑制。由于酮咯酸无中枢性呼吸抑制作用,它可能是心脏手术患者术前用药时吗啡的一种有用替代药物。