Hug C C, McLeskey C H, Nahrwold M L, Roizen M F, Stanley T H, Thisted R A, Walawander C A, White P F, Apfelbaum J L, Grasela T H
Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia.
Anesth Analg. 1993 Oct;77(4 Suppl):S21-9.
To investigate clinically important hypotension and bradycardia after induction of anesthesia with propofol, we analyzed data from a Phase IV stepwise study involving 25,981 patients, 1722 institutions, and 1819 anesthesiologists. In Step 1, propofol was used for induction only. In Step 2, propofol was used for induction and then maintenance by intermittent injection. In Step 3, an induction dose was followed by a maintenance infusion. Participants were to be 18-80 yr of age and ASA physical status I-III; they could not have a continuing pregnancy or prior adverse anesthetic experience. Detailed data on demographic, perioperative, and outcome variables were recorded on data collection forms. The overall incidence of hypotension (systolic blood pressure < 90 mm Hg) was 15.7%; 77% of the episodes were recorded within 10 min of induction of anesthesia with propofol. Bradycardia (heart rate < 50 beats/min) occurred in 4.8% of patients, with 42% of the episodes in the first 10 min. Only 1.3% of patients had both hypotension and bradycardia. The incidence of hypotension was significantly higher for the elderly, females, Caucasians, those undergoing abdominal and integumentary procedures, and those given propofol with opioids, benzodiazepines, or propranolol. Bradycardia was significantly more common when propofol was combined with opioids or chronically taken beta-adrenergic receptor-blocking drugs. Bradycardia and hypotension were not commonly associated. Giving this new drug by protocol, even inexperienced anesthesiologists incurred few adverse hemodynamic changes. Hemodynamic changes were transient and rarely (< 0.2%) required drug therapy. Cardiovascular changes and drug interactions were predictable and manageable based on knowledge of the pharmacology of propofol.
为研究丙泊酚诱导麻醉后临床上重要的低血压和心动过缓情况，我们分析了一项IV期逐步研究的数据，该研究涉及25981例患者、1722家机构和1819名麻醉医生。在第1步中，仅使用丙泊酚进行诱导。在第2步中，丙泊酚用于诱导，然后通过间歇注射进行维持。在第3步中，诱导剂量后进行维持输注。参与者年龄为18 - 80岁，ASA身体状况为I - III级；他们不能处于持续妊娠状态或有先前不良麻醉经历。关于人口统计学、围手术期和结局变量的详细数据记录在数据收集表上。低血压（收缩压<90 mmHg）的总体发生率为15.7%；77%的发作记录在丙泊酚诱导麻醉后的10分钟内。心动过缓（心率<50次/分钟）发生在4.8%的患者中，42%的发作发生在前10分钟内。只有1.3%的患者同时出现低血压和心动过缓。老年人、女性、白种人、接受腹部和皮肤手术的患者以及接受丙泊酚与阿片类药物、苯二氮䓬类药物或普萘洛尔联合使用的患者低血压发生率显著更高。当丙泊酚与阿片类药物或长期服用β - 肾上腺素能受体阻滞剂联合使用时，心动过缓明显更常见。心动过缓和低血压通常不相关。按照方案使用这种新药，即使是经验不足的麻醉医生也很少发生不良血流动力学变化。血流动力学变化是短暂的，很少（<0.2%）需要药物治疗。基于丙泊酚药理学知识，心血管变化和药物相互作用是可预测和可管理的。
