Patschke D, Brückner J B, Eberlein H J, Hess W, Tarnow J, Weymar A
Can Anaesth Soc J. 1977 Jan;24(1):57-69. doi: 10.1007/BF03006813.
The acute effects of althesin, etomidate and fentanyl upon haemodynamics, myocardial contractility and oxygen comsumption of the heart were studied in healthy premedicated patients (n = 15) lightly anaesthetized with N2O-O2 (ratio 2:1), 0.3 volumes per cent of halothane and isoflurane respectively. All individuals were ventilated at a normal level. The patients (n = 9) in the halothane group received etomidate 0.3 mg/kg and 20 minutes later althesin 0.075 ml/kg intravenously. In a second group of 6 patients on isoflurane fentanyl 0.01 mg/kg was given. Etomidate did not affect the cardiovascular system significantly. While the decrease in blood pressure after althesin (24 per cent) was the result of a reduction in total peripheral resistance (32 per cent), hypotension associated with fentanyl (23 per cent) was caused by diminished output due to bradycardia (18 per cent). Load data,heart rate, and maximum dp/dt indicated moderate negative inotropic properties only of althesin. Using the complex haemodynamic parameter developed by Bretschneider the myocardial oxygen consumption was calculated. The energy demand of the heart decreased with etomidate, althesin and fentanyl by 14 per cent, 16 per cent and 32 per cent respectively. It is concluded that the risk of cardiovascular depression at induction in patients with impaired myocardial performance and coronary insufficiency can be minimized with etomidate and/or fentanyl.
在15例用N₂O - O₂（比例2:1）、分别含0.3%体积分数氟烷和异氟烷轻度麻醉并已预先用药的健康患者中，研究了阿法沙龙、依托咪酯和芬太尼对血流动力学、心肌收缩力及心脏氧耗的急性影响。所有个体均维持正常水平通气。氟烷组的9例患者静脉注射0.3mg/kg依托咪酯，20分钟后再静脉注射0.075ml/kg阿法沙龙。在异氟烷组的另一组6例患者中给予0.01mg/kg芬太尼。依托咪酯对心血管系统无明显影响。阿法沙龙给药后血压下降（24%）是总外周阻力降低（32%）的结果，而与芬太尼相关的低血压（23%）是由于心动过缓导致心输出量减少（18%）所致。负荷数据、心率及最大dp/dt仅显示阿法沙龙有中度负性肌力作用。利用Bretschneider提出的复合血流动力学参数计算心肌氧耗。依托咪酯、阿法沙龙和芬太尼使心脏能量需求分别降低14%、16%和32%。结论是，对于心肌功能受损和冠状动脉供血不足的患者，诱导期使用依托咪酯和/或芬太尼可将心血管抑制风险降至最低。
