Inagaki Y, Shindo H, Mashimo T, Yoshiya I
Department of Anesthesiology, Osaka University Medical School, Sumiyoshi-ku, Osaka City, Japan.
Anesth Analg. 1997 Aug;85(2):328-35. doi: 10.1097/00000539-199708000-00016.
To investigate the effects of epidural fentanyl infusion on hemodynamic responses to recovery of consciousness and tracheal extubation, we studied 50 unpremedicated patients scheduled for abdominal hysterectomy. All patients underwent epidural catheterization and blind infusion of placebo and study drug. Patients were assigned randomly to three groups: Group I received epidural and intravenous (i.v.) bolus injections and infusion of saline at the rate of 0.2 mL x kg(-1) x h(-1); Group II received an i.v. injection of fentanyl 2 microg/kg for 30 s followed by 25 ng x kg(-1) x min(-1), and Group III received epidural injection and infusion using the same administration regimen as Group II. Anesthesia was induced with and maintained by isoflurane alone in an air-oxygen mixture. The study drug was administered at the start of retroperitoneal suturing. Hemodynamic variables, including systolic and diastolic arterial pressures (SAP and DAP, respectively) and heart rate (HR), were recorded every minute between the start of administration of the study and 5 min after tracheal extubation. During emergence from anesthesia and tracheal extubation, the increases in SAP, DAP, and HR in Groups II and III were significantly diminished (P < 0.05) compared with those in Group I. Arterial pressures, but not HR, were attenuated more significantly in Group III than in Group II during and after tracheal extubation, although the plasma fentanyl concentration was significantly lower (P < 0.01) in Group III (0.64 +/- 0.03 ng/ mL, [mean +/- SD]) than in Group II (1.15 +/- 0.09 ng/mL). The incidence of coughing during and after extubation was also lower with Group III. Suppression of respiratory rate prior to tracheal extubation was similar in the two groups receiving fentanyl. These findings suggest that the significant reduction in arterial pressures responses to tracheal extubation due to epidural fentanyl infusion may arise from more suppression of cough reflex than i.v. fentanyl infusion, which could be provided by the spinal action of epidural fentanyl as well as the supraspinal action.
为研究硬膜外输注芬太尼对意识恢复和气管拔管时血流动力学反应的影响，我们对50例计划行腹式子宫切除术、未使用术前药的患者进行了研究。所有患者均接受硬膜外导管置入，并盲目输注安慰剂和研究药物。患者被随机分为三组：第一组接受硬膜外和静脉推注及以0.2 mL·kg⁻¹·h⁻¹的速率输注生理盐水；第二组静脉注射2 μg/kg芬太尼30秒，随后以25 ng·kg⁻¹·min⁻¹的速率输注；第三组采用与第二组相同的给药方案进行硬膜外注射和输注。麻醉诱导和维持均仅使用异氟醚与空气 - 氧气混合气体。研究药物在腹膜后缝合开始时给予。在研究药物给药开始至气管拔管后5分钟期间，每分钟记录血流动力学变量，包括收缩压和舒张压（分别为SAP和DAP）以及心率（HR）。在麻醉苏醒和气管拔管期间，与第一组相比，第二组和第三组的SAP、DAP和HR升高明显减轻（P < 0.05）。在气管拔管期间及之后，第三组的动脉压（而非HR）比第二组更明显降低，尽管第三组的血浆芬太尼浓度（0.64 ± 0.03 ng/mL，[均值 ± 标准差]）明显低于第二组（1.15 ± 0.09 ng/mL）（P < 0.01）。第三组在拔管期间及之后咳嗽的发生率也较低。在接受芬太尼的两组中，气管拔管前呼吸频率的抑制相似。这些发现表明，硬膜外输注芬太尼导致气管拔管时动脉压反应显著降低，可能是因为比静脉输注芬太尼更多地抑制了咳嗽反射，这可能由硬膜外芬太尼的脊髓作用以及脊髓上作用共同提供。
