口服可乐定术前用药可降低异氟烷的苏醒浓度。

Oral clonidine premedication reduces the awakening concentration of isoflurane.

作者信息

Goyagi T, Tanaka M, Nishikawa T

机构信息

Department of Anesthesia and Critical Care Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.

出版信息

Anesth Analg. 1998 Feb;86(2):410-3. doi: 10.1097/00000539-199802000-00036.

DOI:10.1097/00000539-199802000-00036

PMID:9459258

Abstract

UNLABELLED

Because clonidine has analgesic and sedative properties, it may influence the awakening concentration or dose of an anesthetic. To investigate the effects of oral clonidine premedication on emergence from isoflurane anesthesia, we studied 61 ASA physical status I or II patients undergoing superficial operations. They were randomly allocated to one of three groups according to the dose of clonidine they received: the clonidine-2.5 group (n = 21), clonidine-5 group (n = 20), and control group (n = 20) received approximately 2.5, 5, or 0 microg/kg oral clonidine, respectively, in addition to 20 mg of famotidine 90 min before general anesthesia induction. Anesthesia was induced by thiamylal 5 mg/kg, and tracheal intubation was facilitated with succinylcholine 1.5 mg/kg I.V. Anesthesia was maintained with a 1.1% end-tidal isoflurane concentration and 67% N2O in oxygen, while ventilation was controlled to maintain end-tidal CO2 tension between 33 and 38 mm Hg. After surgery, N2O was discontinued while the end-tidal isoflurane concentration was maintained at 1.1%. After confirming the end-tidal N2O concentration of 0%, isoflurane was discontinued. The end-tidal isoflurane concentration at the time when patients responded to a standardized verbal command to open their eyes was recorded as MAC-Awake. The MAC-Awake values in the clonidine-5 group (0.22% +/- 0.09% [mean +/- SD]) was significantly less than those in the clonidine-2.5 and control groups (0.28% +/- 0.07% and 0.30% +/- 0.07%, respectively, P < 0.05). The wake-up time, from discontinuance of isoflurane until arousal, was longer in the clonidine-2.5 and clonidine-5 groups than in the control group (17.3 +/- 8.0, 16.9 +/- 7.0, and 10.6 +/- 5.3 min, respectively; P < 0.05). In conclusion, oral clonidine premedication 5 microg/kg decreases the awakening concentration of isoflurane, and arousal from isoflurane anesthesia is prolonged with oral clonidine in a dose of 2.5-5 microg/kg.

IMPLICATIONS

Preanesthetic medication with oral clonidine, 2.5-5 microg/kg, is associated with prolonged recovery from isoflurane anesthesia in adults.

摘要

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由于可乐定具有镇痛和镇静特性，它可能会影响麻醉药的苏醒浓度或剂量。为研究口服可乐定术前用药对异氟烷麻醉苏醒的影响，我们对61例接受浅表手术的美国麻醉医师协会（ASA）身体状况I或II级患者进行了研究。根据他们接受的可乐定剂量，将他们随机分为三组：可乐定-2.5组（n = 21）、可乐定-5组（n = 20）和对照组（n = 20），除了在全身麻醉诱导前90分钟给予20毫克法莫替丁外，分别给予约2.5、5或0微克/千克口服可乐定。用硫喷妥钠5毫克/千克诱导麻醉，并用琥珀酰胆碱1.5毫克/千克静脉注射辅助气管插管。用1.1%的呼气末异氟烷浓度和67%的氧化亚氮与氧气混合维持麻醉，同时控制通气以维持呼气末二氧化碳分压在33至38毫米汞柱之间。手术后，停止使用氧化亚氮，同时将呼气末异氟烷浓度维持在1.1%。在确认呼气末氧化亚氮浓度为0%后，停止使用异氟烷。将患者对标准化口头指令睁眼做出反应时的呼气末异氟烷浓度记录为最低肺泡有效浓度-苏醒（MAC-Awake）。可乐定-5组的MAC-Awake值（0.22%±0.09%[平均值±标准差]）显著低于可乐定-2.5组和对照组（分别为0.28%±0.07%和0.30%±0.07%，P<0.05）。从停止使用异氟烷到苏醒的苏醒时间，可乐定-2.5组和可乐定-5组比对照组更长（分别为17.3±8.0、16.9±7.0和10.6±5.3分钟；P<0.05）。总之，口服5微克/千克可乐定术前用药可降低异氟烷的苏醒浓度，且2.5 - 5微克/千克剂量的口服可乐定可延长异氟烷麻醉后的苏醒时间。