Hans P, Coussaert E, Cantraine F, Dewandre P Y, Brichant J F, Grevesse M, Lamy M
Department of Anesthesia & Intensive Care Medicine, University Hospital of Liège, Domaine Universitaire du Sart Tilman, Belgium.
Acta Anaesthesiol Belg. 1998;49(1):7-11.
The effects of target-controlled anesthesia with propofol and sufentanil on the hemodynamic response to Mayfield head holder (MH) application were evaluated in 18 ASA I and II patients undergoing scheduled intracranial surgery. Premedication consisted of hydroxyzine, alprazolam and atropine given orally 1 h before surgery. Anesthesia was provided with propofol and sufentanil using a target-controlled infusion device; constant calculated plasma concentrations of 4 micrograms ml-1 propofol and 0.5 ng ml-1 sufentanil were maintained throughout the study. Muscle relaxation was obtained with atracurium and ventilation was controlled with air/oxygen. The MH was fixed 45 +/- 12 min (mean +/- SD) after induction of anesthesia. Heart rate and systolic, diastolic, and mean non invasive arterial pressure were monitored and recorded 5 min before induction of anesthesia (control), 1 min before MH application (MH-1), at MH application, and 1 and 2 min after MH application. Systolic, diastolic, mean arterial pressure, and heart rate increased significantly during and after MH application when compared with MH-1 values, but remained constantly lower than control. Hemodynamic parameters measured 1 min before MH application were significantly lower than control. The results of the study indicate that target-controlled anesthesia maintained with constant calculated plasma concentrations of 4 micrograms ml-1 propofol and 0.5 ng ml-1 sufentanil prevents the increase in arterial pressure and heart rate beyond control values following MH application but may induce some degree of arterial hypotension in the absence of nociceptive stimulation.
在18例接受择期颅内手术的美国麻醉医师协会（ASA）I级和II级患者中，评估了丙泊酚和舒芬太尼靶控麻醉对应用梅菲尔德头架（MH）时血流动力学反应的影响。术前用药包括在手术前1小时口服羟嗪、阿普唑仑和阿托品。使用靶控输注装置给予丙泊酚和舒芬太尼进行麻醉；在整个研究过程中，维持丙泊酚血浆浓度为4微克/毫升和舒芬太尼血浆浓度为0.5纳克/毫升的恒定计算值。使用阿曲库铵实现肌肉松弛，通过空气/氧气控制通气。在麻醉诱导后45±12分钟（平均值±标准差）固定MH。在麻醉诱导前5分钟（对照）、应用MH前1分钟（MH-1）、应用MH时以及应用MH后1分钟和2分钟监测并记录心率以及收缩压、舒张压和平均无创动脉压。与MH-1值相比，应用MH期间和之后收缩压、舒张压、平均动脉压和心率显著升高，但始终低于对照值。应用MH前1分钟测量的血流动力学参数显著低于对照值。研究结果表明，维持丙泊酚血浆浓度为4微克/毫升和舒芬太尼血浆浓度为0.5纳克/毫升的恒定计算值的靶控麻醉可防止应用MH后动脉压和心率升高超过对照值，但在无伤害性刺激的情况下可能会诱发一定程度的动脉低血压。
