Fösel T, Cartarius R C, Grüness V, Wilhelm W, Gebauer K, Probst M
Abteilung für Anästhesie und operative Intensivmedizin, Kreiskrankenhaus Lahr.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1996 Feb;31(1):22-5. doi: 10.1055/s-2007-995862.
The aim of this study was to investigate the influence of intranasally administered midazolam in different doses on spontaneous respiration in children.
40 children received in randomised order 0.2, 0.4 or 0.6 mg/kg b.w. midazolam intranasally or NaCl 0.9% as control. 10 minutes later, anaesthesia was induced by inhalation of halothane, nitrous oxide and oxygen. The children were breathing spontaneously at a PEEP of 5 cm H2O on a circle system with a fresh gas flow of 61/min (FIO2 = 0.33). Intubation was performed in deep anaesthesia without muscle relaxant. Halothane concentration was reduced to an endtidal concentration of 0.4 Vol%. With a baby pneumotachograph, minute ventilation, tidal volume, peak inspiratory and expiratory flow and respiratory rate were recorded during quiet breathing. Endtidal pCO2 was measured. Ventilation was then stimulated with 0.2 and 0.41/min CO2 and the same parameters were recorded. Regression analysis was performed for minute ventilation and endtidal pCO2 to obtain the slope which is a parameter for the sensitivity of the chemoreceptor mediated control of ventilation.
The tidal volume and peak inspiratory flow were significantly reduced for a dose of 0.6 mg/kg compared to the control group. No statistical difference could be found for any other parameter between the control and study groups.
We conclude that nasally administered midazolam reduces tidal volume and inspiratory peak flow in spontaneously breathing children at a dose of 0.6 mg/kg b.w. compared to control during halothane--nitrous oxide--oxygen anaesthesia. The CO2 mediated control of respiration under this condition is preserved.
本研究旨在探讨不同剂量鼻内给予咪达唑仑对儿童自主呼吸的影响。
40名儿童按随机顺序接受0.2、0.4或0.6mg/kg体重的鼻内咪达唑仑或0.9%氯化钠溶液作为对照。10分钟后，通过吸入氟烷、氧化亚氮和氧气诱导麻醉。儿童在压力支持通气（PEEP）为5cmH₂O的循环系统上自主呼吸，新鲜气体流量为6L/分钟（FIO₂ = 0.33）。在无肌肉松弛剂的深度麻醉下进行插管。将氟烷浓度降至呼气末浓度0.4Vol%。使用婴儿呼吸流速仪，在安静呼吸期间记录分钟通气量、潮气量、吸气峰流速和呼气峰流速以及呼吸频率。测量呼气末pCO₂。然后用0.2和0.4L/分钟的二氧化碳刺激通气，并记录相同参数。对分钟通气量和呼气末pCO₂进行回归分析，以获得斜率，该斜率是化学感受器介导的通气控制敏感性的一个参数。
与对照组相比，0.6mg/kg剂量的咪达唑仑使潮气量和吸气峰流速显著降低。对照组和研究组之间的任何其他参数均未发现统计学差异。
我们得出结论，在氟烷 - 氧化亚氮 - 氧气麻醉期间，与对照组相比，鼻内给予咪达唑仑在剂量为0.6mg/kg体重时会降低自主呼吸儿童的潮气量和吸气峰流速。在这种情况下，二氧化碳介导的呼吸控制得以保留。
