Yee J B, Burns T A, Mann J M, Crandall A S
Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, USA.
J Clin Anesth. 1996 Dec;8(8):623-6. doi: 10.1016/s0952-8180(96)00137-7.
To determine if the addition of alfentanil to propofol is more effective than propofol alone to provide adequate conditions for placement of a retrobulbar block prior to cataract surgery.
Randomized, double-blinded study.
Outpatients at a university hospital.
40 adult ASA physical status I, II, and III outpatients scheduled for elective cataract surgery.
Patients were randomly assigned to receive one of four drug combinations prior to the placement of a retrobulbar block: Group 1, propofol alone; Group 2, alfentanil 5 micrograms/kg plus propofol; Group 3, alfentanil 10 micrograms/kg plus propofol; Group 4, alfentanil 15 micrograms/kg plus propofol. All patients were preoxygenated by face mask for two minutes prior to drug administration. The quality of conditions for block placement were determined by: (1) assessing the amount of movement by the patients while the block needle was in place, (2) cooperativeness of the patients during the operation, (3) hemodynamic side effects, (4) incidence and severity of respiratory depression, (5) incidence of nausea and vomiting, (6) recall of placement of the block, and (7) time to discharge from the hospital.
The addition of alfentanil to propofol for sedation prior to placement of the retrobulbar block resulted in a dose-dependent reduction in movement by the patients. However, the highest dose of alfentanil (15 micrograms/kg) resulted in the greatest frequency (40% of the patients in this group) of respiratory depression (SpO2 < 90%). All patients were cooperative during the operation and responsive to verbal command within 5 minutes of placement of the block. In addition, all of the patients denied being nauseated, having vomited, or recalling block placement in the recovery room or the next day.
The combination of alfentanil and propofol may be used to sedate patients in order to limit movement and provide a cooperative, alert patient with stable hemodynamics and limited respiratory depression during placement of retrobulbar block prior to ophthalmic surgery. However, excessive dosage of these drugs may result in hazardous respiratory depression in this patient population.
确定在白内障手术前球后阻滞操作前，丙泊酚中加入阿芬太尼是否比单独使用丙泊酚更有效地提供合适条件。
随机双盲研究。
大学医院门诊。
40例计划进行择期白内障手术的ASA身体状况为I、II和III级的成年门诊患者。
在球后阻滞操作前，患者被随机分配接受四种药物组合之一：第1组，仅丙泊酚；第2组，阿芬太尼5微克/千克加丙泊酚；第3组，阿芬太尼10微克/千克加丙泊酚；第4组，阿芬太尼15微克/千克加丙泊酚。所有患者在给药前通过面罩预充氧两分钟。阻滞操作条件的质量通过以下方面确定：（1）评估阻滞针在位时患者的活动量；（2）患者在手术期间的配合程度；（3）血流动力学副作用；（4）呼吸抑制的发生率和严重程度；（5）恶心和呕吐的发生率；（6）对阻滞操作的回忆情况；（7）出院时间。
在球后阻滞操作前使用丙泊酚镇静时加入阿芬太尼，可使患者的活动量呈剂量依赖性减少。然而，阿芬太尼最高剂量（15微克/千克）导致呼吸抑制（SpO2 < 90%）的发生率最高（该组患者的40%）。所有患者在手术期间均配合，且在阻滞操作后5分钟内对言语指令有反应。此外，所有患者均否认在恢复室或次日感到恶心、呕吐或回忆起阻滞操作。
阿芬太尼和丙泊酚联合使用可用于使患者镇静，以限制活动，并在眼科手术前球后阻滞操作期间为配合良好、意识清醒的患者提供稳定的血流动力学和有限的呼吸抑制。然而，这些药物的过量使用可能导致该患者群体出现危险的呼吸抑制。
