Hans P, Lamy M M, Brichant J F, Cantraine F, Coussaert E, Byttebier G, Lamy M L
University Department of Anesthesia & Intensive Care Medicine, CHR Citadelle, Liège, Belgium.
Acta Anaesthesiol Belg. 1998;49(1):13-9.
The study was designed to characterise the emergence from target-controlled anesthesia assessed by the recovery of spontaneous breathing, eye opening to command, and extubation in 18 adult patients undergoing intracranial surgery. Total intravenous anesthesia was induced and maintained with propofol and sufentanil. Target plasma concentration of propofol ranged between 3.0 and 5.5 micrograms.ml-1 and infusion was stopped after head dressing. The initial target plasma sufentanil concentration of 0.50 ng.ml-1 was decreased to 0.15 ng.ml-1 after craniotomy; sufentanil infusion was discontinued at the dura closure. The time from the end of surgery (head dressing) to recovery of spontaneous breathing was 8.3 +/- 6.5 min, and the time to eye opening and extubation was 14.7 +/- 10.0 min. At the end of surgery, the calculated plasma propofol concentration was 3.42 +/- 0.26 micrograms.ml-1. It significantly decreased to 2.11 +/- 0.51 micrograms.ml-1 at recovery of spontaneous breathing and to 1.81 +/- 0.41 micrograms.ml-1 at eye opening and extubation. The calculated plasma sufentanil concentration was 0.108 +/- 0.019 ng.ml-1 at the end of surgery but did not change significantly between recovery of spontaneous breathing (0.089 +/- 0.013 ng.ml-1), eye opening and extubation (0.087 +/- 0.013 ng.ml-1). The calculated plasma propofol concentrations recorded at emergence were not correlated with patient age, total dose of propofol, and duration of infusion; corresponding calculated sufentanil concentrations were not correlated with age and total dose of sufentanil. An inverse relationship (p < 0.05) was found between the duration of sufentanil infusion and the calculated sufentanil concentrations at emergence. No correlation was observed between calculated concentrations of propofol and sufentanil at emergence.
本研究旨在通过对18例接受颅内手术的成年患者自主呼吸恢复、对指令睁眼和拔管情况的评估，来描述靶控麻醉的苏醒过程。采用丙泊酚和舒芬太尼诱导并维持全静脉麻醉。丙泊酚的靶血浆浓度范围为3.0至5.5微克·毫升-1，头部包扎后停止输注。舒芬太尼的初始靶血浆浓度为0.50纳克·毫升-1，开颅术后降至0.15纳克·毫升-1；硬脑膜关闭时停止舒芬太尼输注。从手术结束（头部包扎）到自主呼吸恢复的时间为8.3±6.5分钟，睁眼和拔管时间为14.7±10.0分钟。手术结束时，计算得出的血浆丙泊酚浓度为3.42±0.26微克·毫升-1。自主呼吸恢复时显著降至2.11±0.51微克·毫升-1，睁眼和拔管时降至1.81±0.41微克·毫升-1。手术结束时计算得出的血浆舒芬太尼浓度为0.108±0.019纳克·毫升-1，但在自主呼吸恢复（0.089±0.013纳克·毫升-1）、睁眼和拔管（0.087±0.013纳克·毫升-1）之间无显著变化。苏醒时记录的计算得出的血浆丙泊酚浓度与患者年龄、丙泊酚总剂量及输注持续时间无关；相应的计算得出的舒芬太尼浓度与年龄和舒芬太尼总剂量无关。发现舒芬太尼输注持续时间与苏醒时计算得出的舒芬太尼浓度呈负相关（p<0.05）。苏醒时计算得出的丙泊酚和舒芬太尼浓度之间未观察到相关性。
