Illievich U M, Petricek W, Schramm W, Weindlmayr-Goettel M, Czech T, Spiss C K
Clinic of Anesthesia, University of Vienna, School of Medicine, Austria.
Anesth Analg. 1993 Jul;77(1):155-60.
The hemodynamic effects of a propofol infusion adjusted to achieve and maintain a burst-suppression pattern [episodes of depressed background activity (electrical silence) more than 4 s alternating with a high-voltage slow activity], were studied in 10 patients without cardiorespiratory disease undergoing elective neurosurgical interventions. Propofol infusion was started after a bolus dose of 1 mg/kg at a rate of 20 mg.kg-1 x h-1, reduced after 30 min to 15 mg.kg-1 x h-1, and terminated after 60 min (1926 +/- 346 mg cumulative propofol dose, maximal serum concentration 9.2 +/- 2.9 micrograms/dL; mean +/- SD). Hemodynamic data and arterial blood samples were collected during a sedated, resting control period, and then every 15 min during drug infusion. Lactated Ringer's solution was infused at a rate sufficient to maintain pulmonary capillary wedge pressure at or above control levels (20-30 mL.kg-1 x h-1). Burst-suppression pattern in the electroencephalogram was achieved after 15.7 +/- 3.2 min and maintained until 10.9 +/- 2.6 min after the propofol infusion was terminated. Significant decreases (% of control, Friedman and Wilcoxon Wilcox test, P < 0.05) were found in heart rate (19%), mean arterial pressure (20%), cardiac index (23%), and left ventricular stroke work index (26%). No adverse consequences were caused by the propofol or crystalloid infusion. The results demonstrate that doses of propofol sufficient to silence the electroencephalogram are associated with venodilating and myocardial depressant properties. However, propofol can be administered with minimal hemodynamic risk in healthy patients when cardiac filling pressures are maintained by intravenous fluid administration.
在10例接受择期神经外科手术且无心肺疾病的患者中，研究了调整丙泊酚输注速率以达到并维持爆发抑制模式（背景活动抑制期（电静息）超过4秒，与高电压慢活动交替出现）时的血流动力学效应。在给予1mg/kg的负荷剂量后，开始以20mg·kg⁻¹·h⁻¹的速率输注丙泊酚，30分钟后减至15mg·kg⁻¹·h⁻¹，并在60分钟后停止输注（丙泊酚累积剂量为1926±346mg，最大血清浓度为9.2±2.9μg/dL；均值±标准差）。在镇静、静息对照期收集血流动力学数据和动脉血样本，然后在药物输注期间每15分钟收集一次。以足以维持肺毛细血管楔压在对照水平或以上的速率输注乳酸林格氏液（20 - 30mL·kg⁻¹·h⁻¹）。脑电图中的爆发抑制模式在15.7±3.2分钟后达到，并维持至丙泊酚输注停止后10.9±2.6分钟。发现心率（下降19%）、平均动脉压（下降20%）、心脏指数（下降23%）和左心室每搏功指数（下降26%）有显著降低（相对于对照的百分比，Friedman和Wilcoxon Wilcox检验，P < 0.05）。丙泊酚或晶体液输注未引起不良后果。结果表明，足以使脑电图静止的丙泊酚剂量具有血管舒张和心肌抑制特性。然而，在通过静脉输液维持心脏充盈压时，丙泊酚可在健康患者中以最小的血流动力学风险给药。
