Avramov M N, Griffin J D, White P F
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 75235-9068, USA.
Anesth Analg. 1998 Sep;87(3):666-70. doi: 10.1097/00000539-199809000-00033.
We evaluated the effect of the fresh gas flow (FGF) rate and the anesthetic technique on the ability to control the acute hyperdynamic response to a specific surgical stimulus during surgery in 90 consenting ASA physical status I-III patients undergoing lower abdominal procedures. After the administration of midazolam 2 mg IV, anesthesia was induced in all patients with propofol 1.5 mg/kg IV and fentanyl 1 microg/kg IV and was initially maintained with desflurane or isoflurane, 0.7 minimum alveolar anesthetic concentration, at total FGF rates of either 1 or 3 L/min. In response to the surgical stimulation of skin incision and retropubic dissection, an increase in mean arterial pressure (MAP) >20% above the preincision baseline MAP value provoked a stepwise increase in the inspired concentration of the volatile anesthetic or the IV administration of a variable-rate infusion of esmolol. At both FGF rates, the acute hemodynamic response to surgical stimulation was more efficiently treated by increasing the inspired concentration of desflurane than isoflurane. At 1 L/min, the average time to control the increase in MAP was significantly shorter with desflurane (17+/-12 min) compared with isoflurane (29+/-16 min), with 60% of the patients in the isoflurane group requiring rescue therapy. When an esmolol infusion was used to control the increase in MAP, supplementation with fentanyl was required in 40% and 53% of patients anesthetized with desflurane and isoflurane, respectively. In conclusion, desflurane provided more rapid and reliable control of acute hemodynamic responses to surgical stimulation than isoflurane or esmolol when the volatile anesthetics were administered at low FGF rates.
At low fresh gas flow rates (1 L/min), desflurane more successfully and rapidly controlled the acute hemodynamic responses to painful surgical stimuli than isoflurane.
我们评估了新鲜气流（FGF）速率和麻醉技术对90例自愿接受手术的美国麻醉医师协会（ASA）身体状况为I-III级、正在接受下腹部手术的患者在手术期间控制对特定手术刺激的急性高动力反应能力的影响。静脉注射2 mg咪达唑仑后，所有患者均用1.5 mg/kg静脉注射丙泊酚和1 μg/kg静脉注射芬太尼诱导麻醉，最初用地氟烷或异氟烷维持麻醉，最低肺泡气麻醉浓度为0.7，总FGF速率为1或3 L/min。针对皮肤切口和耻骨后解剖的手术刺激，平均动脉压（MAP）比切口前基线MAP值升高>20%会引发挥发性麻醉剂吸入浓度的逐步增加或静脉注射可变速率的艾司洛尔。在两种FGF速率下，与异氟烷相比，增加地氟烷的吸入浓度能更有效地治疗对手术刺激的急性血流动力学反应。在1 L/min时，与异氟烷（29±16分钟）相比，地氟烷控制MAP升高的平均时间显著更短（17±12分钟），异氟烷组60%的患者需要抢救治疗。当使用艾司洛尔输注来控制MAP升高时，分别有40%和53%接受地氟烷和异氟烷麻醉的患者需要补充芬太尼。总之，当以低FGF速率给予挥发性麻醉剂时，地氟烷比异氟烷或艾司洛尔能更快速、可靠地控制对手术刺激的急性血流动力学反应。
在低新鲜气流速率（1 L/min）下，地氟烷比异氟烷更成功、快速地控制对疼痛手术刺激的急性血流动力学反应。
