Doblar D D, Lim Y C, Baykan N, Frenette L
Department of Anesthesiology, University of Alabama, Birmingham 35233, USA.
J Clin Anesth. 1996 Feb;8(1):31-5. doi: 10.1016/0952-8180(95)00169-7.
To compare the effects of four techniques for preventing or blunting the hypertensive response to the insertion of Mayfield headrest skull pins: intravenous (IV) alfentanil (ALF), esmolol (ESM), thiopental sodium (TPL), and local anesthesia using plain lidocaine (Xylocaine; XYL).
Randomized open study.
40 adult patients undergoing intracranial or spinal surgery requiring the use of Mayfield headrest skull pins for head positioning and immobilization.
20 minutes after anesthetic induction, and 2 to 3 minutes prior to the insertion of headrest skull pins, one of three drugs was administered IV: ALF 10 mcg/kg, ESM 1 mg/kg, or TPL 1.5 mg/kg. The fourth drug, XYL, was administered by injection into the scalp.
Blood pressure and heart rate (HR) were recorded immediately prior to and after pin insertion with balanced general anesthesia, and at 30, 60, 120, and 180-second intervals after pin insertion. The measurements were compared with the immediate preinsertion values. In the ALF and XYL groups, there was no significant increase in mean arterial pressure (MAP) or HR for any of the measurement periods. MAP was elevated immediately on pin insertion and for up to 2 minutes in the TPL group, and for up to 3 minutes in the ESM group (p < 0.05). HR changes were seen in the TPL group for up to one minute (p < 0.05). Increases in systolic blood pressure were seen in the TPL and ESM groups for up to 3 minutes, and in diastolic blood pressure for up to 2 minutes (p < 0.05). No other significant changes were observed.
IV ALF and local injection of XYL in the scalp prevent the hemodynamic response to the insertion of skull pins in anesthetized patients. Neither ESM nor TPL prevented the hypertensive response. Local anesthetic injection into the scalp requires coordination between the anesthesiologist and surgeon, it carries the risk of needle stick injury, and it must be repeated if the surgeon repositions the headrest. The rapid onset and short half-life of ALF, coupled with the absence of hemodynamic effects at the dose used, makes this drug an alternative to the use of XYL injection.
比较四种预防或减轻使用梅菲尔德头架颅骨钉时高血压反应的技术的效果：静脉注射（IV）阿芬太尼（ALF）、艾司洛尔（ESM）、硫喷妥钠（TPL）以及使用普通利多卡因（赛罗卡因；XYL）进行局部麻醉。
随机开放研究。
40例接受颅内或脊柱手术的成年患者，手术需要使用梅菲尔德头架颅骨钉进行头部定位和固定。
麻醉诱导后20分钟，以及插入头架颅骨钉前2至3分钟，静脉注射三种药物之一：阿芬太尼10 mcg/kg、艾司洛尔1 mg/kg或硫喷妥钠1.5 mg/kg。第四种药物XYL通过注射到头皮给药。
在平衡全身麻醉下，插入颅骨钉之前和之后立即记录血压和心率（HR），并在插入颅骨钉后30、60、120和180秒间隔记录。将测量结果与插入前的即时值进行比较。在ALF组和XYL组中，任何测量时间段内平均动脉压（MAP）或HR均无显著升高。在TPL组中，插入颅骨钉后MAP立即升高并持续2分钟，在ESM组中持续3分钟（p<0.05）。TPL组中HR变化持续长达1分钟（p<0.05）。TPL组和ESM组中收缩压升高持续长达3分钟，舒张压升高持续长达2分钟（p<0.
