Thomson I R, Henderson B T, Singh K, Hudson R J
Department of Anesthesia, University of Manitoba, Winnipeg, Canada.
Anesthesiology. 1998 Oct;89(4):852-61. doi: 10.1097/00000542-199810000-00009.
Concentration-response relationships for sufentanil and fentanyl are undefined in patients undergoing coronary artery bypass grafting.
Separate studies of sufentanil and fentanyl were performed in lorazepam-premedicated patients undergoing coronary artery bypass grafting. Patients were assigned randomly to groups with different prebypass effect-site opioid concentrations targeted by computer-assisted infusion. The target sufentanil concentrations were 0.4 ng/ml (group LS, n = 11), 0.8 ng/ml (group MS, n = 10), and 1.2 ng/ml (group HS, n = 11); the target fentanyl concentrations were 5 ng/ml (group LF, n = 7), 10 ng/ml (group MF, n = 7), and 15 ng/ml (group HF, n = 6). Propofol at a dose of 1 mg/kg was administered at induction of anesthesia and isoflurane was used for hemodynamic control Hemodynamics, end-tidal isoflurane concentration, and opioid concentration in arterial blood were measured at specific intervals.
Intraoperative opioid concentrations were constant, averaging 0.71 +/- 0.13, 1.25 +/- 0.21, and 2.03 +/- 0.46 ng/ml for groups LS, MS, and HS, respectively, and 7.3 +/- 1.1, 13.2 +/- 2.2, and 24.4 +/- 5.8 ng/ml for groups LF, MF, and HF, respectively (all mean +/- SD). Isoflurane requirements were significantly greater in group LS than in groups MS and HS and greater in group LF than in groups MF and HF. The serum opioid and end-tidal isoflurane concentrations were correlated significantly. There were no intergroup differences in hemodynamics.
Serum sufentanil and fentanyl concentrations of 0.71 +/- 0.13 ng/ml and 7.3 +/- 1.3 ng/ml, respectively, are on the steep parts of the concentration-response relationships and facilitate prebypass hemodynamic control in patients undergoing coronary artery bypass grafting with opioid-isoflurane anesthesia. Concentrations of sufentanil > or = 1.25 +/- 0.21 ng/ml and of fentanyl > or = 13.3 +/- 2.2 ng/ml minimize isoflurane requirements but do not improve hemodynamic control.
在接受冠状动脉搭桥手术的患者中，舒芬太尼和芬太尼的浓度-效应关系尚不明确。
对接受冠状动脉搭桥手术且已用劳拉西泮预处理的患者分别进行舒芬太尼和芬太尼的研究。患者被随机分配到不同组，通过计算机辅助输注将体外循环前效应室阿片类药物浓度设定为不同目标值。舒芬太尼的目标浓度分别为0.4纳克/毫升（LS组，n = 11）、0.8纳克/毫升（MS组，n = 10）和1.2纳克/毫升（HS组，n = 11）；芬太尼的目标浓度分别为5纳克/毫升（LF组，n = 7）、10纳克/毫升（MF组，n = 7）和15纳克/毫升（HF组，n = 6）。麻醉诱导时给予1毫克/千克的丙泊酚，并用异氟烷进行血流动力学控制。在特定时间间隔测量血流动力学、呼气末异氟烷浓度和动脉血中的阿片类药物浓度。
术中阿片类药物浓度保持恒定，LS组、MS组和HS组的平均浓度分别为0.71±0.13、1.25±0.21和2.03±0.46纳克/毫升，LF组、MF组和HF组分别为7.3±1.1、13.2±2.2和24.4±5.8纳克/毫升（均为平均值±标准差）。LS组的异氟烷需求量显著高于MS组和HS组，LF组的异氟烷需求量显著高于MF组和HF组。血清阿片类药物浓度与呼气末异氟烷浓度显著相关。血流动力学方面各组间无差异。
血清舒芬太尼和芬太尼浓度分别为0.71±0.13纳克/毫升和7.3±1.3纳克/毫升时，处于浓度-效应关系的陡峭部分，有助于在接受阿片类药物-异氟烷麻醉的冠状动脉搭桥手术患者中进行体外循环前的血流动力学控制。舒芬太尼浓度≥1.25±0.21纳克/毫升和芬太尼浓度≥13.3±2.2纳克/毫升可使异氟烷需求量降至最低，但并不能改善血流动力学控制。
