Johansen J W, Schneider G, Windsor A M, Sebel P S
Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA.
Anesth Analg. 1998 Sep;87(3):671-6. doi: 10.1097/00000539-199809000-00034.
Esmolol, a short-acting beta1-receptor antagonist, decreases anesthetic requirements during propofol/N2O/morphine anesthesia. This study was designed to determine whether esmolol affects the volatile anesthetic (isoflurane) required to prevent movement to skin incision in 50% patients (minimum alveolar anesthetic concentration [MAC]) with or without an additional opioid (alfentanil). One hundred consenting adult patients were randomly divided into five treatment groups: isoflurane alone (I), I with continuous large-dose (250 microg x kg(-1) x min(-1)) esmolol (E), I with alfentanil (effect site target of 50 ng/mL) via a continuous computer-controlled infusion (A), A plus continuous small-dose (50 microg x kg(-1) x min(-1)) esmolol (A1), or A plus large-dose esmolol (A2). Anesthesia was induced via a face mask, and steady-state target end-tidal isoflurane concentrations were maintained before incision. The MAC of isoflurane alone was 1.28% +/- 0.13%. Large-dose esmolol did not significantly alter the isoflurane MAC (1.23% +/- 0.14%). Alfentanil alone significantly decreased isoflurane MAC by 25% (0.96% +/-0.09%). Adding small-dose esmolol did not further decrease MAC with alfentanil (0.96% +/- 0.13%). However, large-dose esmolol significantly decreased isoflurane MAC with alfentanil (0.74% +/- 0.09%). Esmolol and alfentanil both significantly reduced the increases in heart rate and mean arterial pressure associated with endotracheal intubation and incision. The mechanism of this effect is unknown.
Most anesthetic techniques rely on a balance of several highly selective medications. The current results define a new anesthetic-sparing effect when volatile anesthetic, analgesic, and beta-adrenergic blocking drugs are combined.
艾司洛尔是一种短效β1受体拮抗剂，可降低丙泊酚/氧化亚氮/吗啡麻醉期间的麻醉需求。本研究旨在确定艾司洛尔是否会影响在有或没有额外阿片类药物（阿芬太尼）的情况下，使50%患者在皮肤切开时不发生体动所需的挥发性麻醉药（异氟烷）浓度（最低肺泡有效浓度[MAC]）。100名同意参与的成年患者被随机分为五个治疗组：单纯异氟烷组（I）、I组加持续大剂量（250μg·kg-1·min-1）艾司洛尔组（E）、I组加通过持续计算机控制输注给予阿芬太尼（效应室靶浓度50ng/mL）组（A）、A组加持续小剂量（50μg·kg-1·min-1）艾司洛尔组（A1）或A组加大剂量艾司洛尔组（A2）。通过面罩诱导麻醉，并在切开前维持稳定状态的目标呼气末异氟烷浓度。单纯异氟烷的MAC为1.28%±0.13%。大剂量艾司洛尔未显著改变异氟烷MAC（1.23%±0.14%）。单独使用阿芬太尼可使异氟烷MAC显著降低25%（0.96%±0.09%）。加用小剂量艾司洛尔并未使阿芬太尼进一步降低MAC（0.96%±0.13%）。然而，大剂量艾司洛尔可使阿芬太尼合用情况下的异氟烷MAC显著降低（0.74%±0.09%）。艾司洛尔和阿芬太尼均显著降低了与气管插管和切开相关的心率及平均动脉压升高。这种作用机制尚不清楚。
大多数麻醉技术依赖于几种高选择性药物的平衡。当前结果确定了挥发性麻醉药、镇痛药和β肾上腺素能阻滞剂联合使用时一种新的节省麻醉药效应。
