Chan V W, Chung F F
Department of Anaesthesia, Toronto Hospital, Ontario, Canada.
J Clin Anesth. 1996 Jun;8(4):317-23. doi: 10.1016/0952-8180(96)00041-4.
To evaluate the effect of propofol infusion for both induction and maintenance of anesthesia on hemodynamics and recovery in elderly patients compared with conventional thiopental-isoflurane anesthesia.
Randomized, prospective, study.
Teaching hospital.
60 nonpremedicated ASA physical status I, II, and III adult elderly patients scheduled to undergo total hip replacement surgery.
Patients received either intravenous propofol infusion at 0.75 mg/kg/min or thiopental bolus 2 to 4 mg/kg for induction, followed by variable-rate propofol infusion up to 0.15 mg/kg/min or isoflurane 0.5% to 1.5% for maintenance of anesthesia. Nitrous oxide and fentanyl supplements were given in all patients.
Perioperative hemodynamic changes, patient recovery profile, and myocardial ischemia incidents were assessed in both anesthetic groups. Induction of anesthesia by propofol infusion (1.6 mg/kg) did not produce significant hypotension (-8.3% +/- 5.5%) or bradycardia; these changes were similar to induction by thiopental bolus injection (3.3 mg/kg). Furthermore, increases in blood pressure and heart rate (HR) during endotracheal intubation were limited to 6% following propofol induction compared with 22% for thiopental induction. During maintenance of anesthesia, the decrease in MAP and HR was comparable in both anesthetic groups. Postanesthetic recovery times for patient to achieve wakefulness, mental orientation, and a maximum Aldrete score (10) were significantly faster in the propofol group, by 4 minutes, 6 minutes, and 20 minutes, respectively; however, the time to discharge from the postanesthesia care unit was not different. Holter-monitored perioperative myocardial ischemic events detected in 23% of the patients occurred independent of hemodynamic changes or the type of anesthetic administered.
Induction of anesthesia by propofol infusion in elderly patients produces greater attenuation of cardiovascular sympathetic response than thiopental bolus induction. Induction and maintenance of anesthesia by propofol infusion results in more rapid recovery in our elderly patients than thiopental isoflurane anesthesia.
与传统硫喷妥钠-异氟烷麻醉相比，评估丙泊酚输注用于老年患者麻醉诱导和维持对血流动力学及恢复情况的影响。
随机、前瞻性研究。
教学医院。
60例未使用术前药、美国麻醉医师协会（ASA）身体状况分级为I、II和III级、计划行全髋关节置换手术的成年老年患者。
患者诱导麻醉时，要么以0.75毫克/千克/分钟的速度静脉输注丙泊酚，要么静脉注射2至4毫克/千克硫喷妥钠，随后以高达0.15毫克/千克/分钟的可变速度输注丙泊酚或用0.5%至1.5%的异氟烷维持麻醉。所有患者均给予氧化亚氮和芬太尼补充剂。
对两个麻醉组的围手术期血流动力学变化、患者恢复情况及心肌缺血事件进行评估。通过丙泊酚输注（1.6毫克/千克）诱导麻醉未产生显著低血压（-8.3%±5.5%）或心动过缓；这些变化与硫喷妥钠静脉推注（3.3毫克/千克）诱导相似。此外，与硫喷妥钠诱导时血压和心率（HR）升高22%相比，则丙泊酚诱导后气管插管期间血压和心率升高限制在6%。在麻醉维持期间，两个麻醉组平均动脉压（MAP）和HR的下降相当。丙泊酚组患者达到清醒、精神定向和最大Aldrete评分（10分）的麻醉后恢复时间分别显著快4分钟、6分钟和20分钟；然而，从麻醉后护理单元出院的时间并无差异。通过动态心电图监测发现，23%的患者围手术期发生心肌缺血事件，其发生与血流动力学变化或所给予的麻醉类型无关。
老年患者通过丙泊酚输注诱导麻醉比硫喷妥钠静脉推注诱导能更大程度地减弱心血管交感神经反应。与硫喷妥钠-异氟烷麻醉相比，通过丙泊酚输注诱导和维持麻醉能使老年患者恢复更快。
