Kazama T, Ikeda K, Morita K, Katoh T, Kikura M
Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Japan.
Anesth Analg. 1998 Apr;86(4):872-9. doi: 10.1097/00000539-199804000-00036.
The administration of fentanyl with propofol reduces the blood concentration of propofol required to achieve adequate anesthesia for tracheal intubation. However, different intubation procedures have variable intensities of noxious stimulation and may require different levels of anesthesia. The goal of this study was to determine the propofol blood concentration at which 50% of patients did not respond to stimulation (Cp50) for laryngoscopy, intubation with a laryngoscope, insertion of a slotted oral-pharyngeal airway (Ovassapian airway), and intubation with a fiberscope when administered in conjunction with fentanyl. Patients undergoing elective surgery were given varying amounts of propofol or propofol with fentanyl, and their responses to the four procedures listed above were assessed. These experiments demonstrated that the propofol concentration required for intubation with a laryngoscope was similar to that for intubation with a fiberscope, and that the required level was reduced by fentanyl. Hemodynamic responses to intubation were lower with a fiberscope than with a laryngoscope. We conclude that almost the same concentrations of propofol or fentanyl are necessary for suppressing both of the somatic responses to tracheal intubation with a fiberscope or a laryngoscope. Hemodynamic responses were attenuated more during intubation with a fiberscope.
The propofol blood concentrations at which 50% of patients did not respond to stimulation for laryngoscopy, tracheal intubation with a laryngoscope, and tracheal intubation with a fiberscope were 10.9, 19.6, and 19.9 microg/mL, respectively. These were reduced by fentanyl. Hemodynamic responses to intubation were less with a fiberscope than with a laryngoscope.
芬太尼与丙泊酚联合使用可降低气管插管达到足够麻醉所需的丙泊酚血药浓度。然而，不同的插管操作产生的有害刺激强度不同，可能需要不同水平的麻醉。本研究的目的是确定在与芬太尼联合使用时，50%的患者对喉镜检查、用喉镜插管、插入带槽口咽气道（奥瓦萨皮安气道）以及用纤维喉镜插管无反应时的丙泊酚血药浓度（Cp50）。接受择期手术的患者给予不同剂量的丙泊酚或丙泊酚与芬太尼联合用药，并评估他们对上述四种操作的反应。这些实验表明，用喉镜插管所需的丙泊酚浓度与用纤维喉镜插管所需的浓度相似，且芬太尼可降低所需浓度水平。纤维喉镜插管时的血流动力学反应低于喉镜插管时。我们得出结论，抑制纤维喉镜或喉镜气管插管的躯体反应所需的丙泊酚或芬太尼浓度几乎相同。纤维喉镜插管时血流动力学反应的减弱更为明显。
50%的患者对喉镜检查、喉镜气管插管和纤维喉镜气管插管无反应时的丙泊酚血药浓度分别为10.9、19.6和19.9μg/mL。这些浓度因芬太尼而降低。纤维喉镜插管时的插管血流动力学反应低于喉镜插管时。
