Sakaida K
Department of Anesthesiology, Funabashi Municipal Medical Center.
Masui. 1998 May;47(5):576-84.
The hemodynamic and respiratory effects of high dose fentanyl anesthesia and those of isoflurane anesthesia with combined use of low dose fentanyl were compared in 40 patients undergoing open heart surgery. Twenty patients (Group Fen) were anesthetized with high dose fentanyl (about 100 micrograms.kg-1), other twenty patients (Group Iso) were anesthetized with isoflurane (inhalation of 1.0-2.0%) combined with low dose fentanyl (about 8 micrograms.kg-1). Between the two groups, there were no significant differences in HR, CI, SVI, MPAP, MRAP, PVRI, RVCWI, LVSWI, DO2I, SvO2, and P/F ratio. In group Iso, there were significant decreases in mean arterial pressure (MAP) and systemic vascular resistance index (SVRI) at the time of sternotomy and before the cardiopulmonary bypass. In group Fen, a significant increase in VO2I occurred at the time of sternotomy. In ICU, catecholamine concentrations were significantly lower, and the duration of its use was significantly shorter in group Iso. Group Iso required significantly less time to awakening and to extubating. Therefore, group Iso shortened the length of ICU stays. In conclusion, isoflurane with combined use of low dose fentanyl anesthesia is an acceptable method of anesthesia for open heart surgery.
对40例接受心脏直视手术的患者比较了大剂量芬太尼麻醉与异氟烷麻醉联合小剂量芬太尼的血流动力学和呼吸效应。20例患者(芬太尼组)采用大剂量芬太尼(约100微克·千克⁻¹)麻醉,另外20例患者(异氟烷组)采用异氟烷(吸入1.0 - 2.0%)联合小剂量芬太尼(约8微克·千克⁻¹)麻醉。两组之间,心率、心脏指数、每搏指数、平均肺动脉压、平均右房压、肺血管阻力指数、右室做功指数、左室做功指数、氧输送指数、混合静脉血氧饱和度和氧合指数均无显著差异。在异氟烷组,胸骨切开时和体外循环前平均动脉压(MAP)和全身血管阻力指数(SVRI)显著下降。在芬太尼组,胸骨切开时氧耗指数显著升高。在重症监护病房(ICU),异氟烷组儿茶酚胺浓度显著降低,使用时间显著缩短。异氟烷组苏醒和拔管所需时间显著缩短。因此,异氟烷组缩短了ICU住院时间。总之,异氟烷联合小剂量芬太尼麻醉是心脏直视手术可接受的麻醉方法。