Dalens B, Mansoor O
Département d'Anesthésie-Réanimation, Hôtel-Dieu, Clermont-Ferrand.
Cah Anesthesiol. 1993;41(3):245-9.
Propofol fulfills most of the requirements for the ideal intravenous agent usable in conjunction with regional anesthesia in children, especially for outpatient surgery. Some limitations are easily overcome by simple means such as contact anesthesia of the skin prior to venous puncture or addition of lidocaine (1 ml 1% lidocaine in 20 ml of propofol). In clinical practice, it is mandatory that the sites of puncture (venous line as well as block technique) be anesthetized by skin application of EMLA cream and that anxious children be given premedication (0.3 mg.kg-1 of rectal midazolam). Recommended induction dose of propofol is 3 to 4 mg.kg-1. Maintenance of anesthesia can be achieved either by continuous infusion of 2 to 5 mg.kg-1.h-1 of propofol or by inhalation anesthesia with low concentrations of halogenated agents. Spontaneous ventilation through a face mask or a laryngeal mask is usually made possible. Satisfactory conditions for performing the regional block technique are especially obtained when the skin at the site of puncture is anesthetized. Adverse effects are unusual and mainly consist of undesirable movements, the occurrence of which is favored by the existence of a differential sensory block. Propofol allows easy and complete post-anesthesia awakening and it has anti emetic and anxiolytic effects: due to these properties, it is remarkably suitable for use in association with regional anesthesia in children.
丙泊酚满足了与儿童区域麻醉联合使用的理想静脉麻醉剂的大部分要求，尤其适用于门诊手术。一些局限性可通过简单的方法轻松克服，如在静脉穿刺前对皮肤进行接触麻醉或加入利多卡因（20ml丙泊酚中加入1ml 1%利多卡因）。在临床实践中，必须通过涂抹EMLA乳膏对穿刺部位（静脉穿刺部位以及阻滞技术部位）进行皮肤麻醉，并对焦虑的儿童给予术前用药（0.3mg·kg⁻¹直肠用咪达唑仑）。丙泊酚的推荐诱导剂量为3至4mg·kg⁻¹。麻醉维持可通过持续输注2至5mg·kg⁻¹·h⁻¹的丙泊酚或低浓度卤化剂吸入麻醉来实现。通常可通过面罩或喉罩进行自主通气。当穿刺部位的皮肤被麻醉时，尤其能获得进行区域阻滞技术的满意条件。不良反应不常见，主要包括不自主运动，感觉差异阻滞的存在会增加其发生几率。丙泊酚可使麻醉后轻松且完全苏醒，并且具有抗呕吐和抗焦虑作用：由于这些特性，它非常适合与儿童区域麻醉联合使用。
