氯胺酮-异丙酚静脉复合麻醉

Ketamine-propofol total intravenous anesthesia

选择28例ASA Ⅰ～Ⅱ级、非心脏手术病人,随机分为氯胺酮-异丙酚静脉复合麻醉(K组,n=14)和芬太尼-异丙酚静脉复合麻醉(F组,n=14)。无术前用药。静注氯铵酮(K组)或芬太尼(F组)、维库溴铵和异丙酚诱导,气管插管。持续静脉泵入氯胺酮(K组)或芬太尼(F组)复合静滴异丙酚维持麻醉。结果诱导后K组血压(BP)和心率(HR)下降明显小于F组,但气管插管反应明显大于F组。K组麻醉后完全清醒时间较F组明显延长。无梦幻和恢复期精神症状。结论:氯胺酮可减轻异丙酚麻醉诱导的心血管抑制作用;异丙酚可有效控制氯胺酮维持期的心血管兴奋和苏醒期精神症状。

Twenty-eight healthy patients who underwent non-cardiac surgery received either ketamine-propofol total intravenous anesthesia(TIVA)(n=14)or fentanyl-propofol TIVA(n=14). All patients were unpremedicated. TIVA was induced with either ketamine lmg/kg or fentanyl 2μg/kg and propofol 2mg/kg intravenously. Tracheal intubation was facilitated with veeuronium 0.09mg/kg. TIVA was maintained with an infusion of ketamine ( 1.44±0.23mg/kg/h )or fentanyl (2.96±0.81μg/kg/h )in combination with an infusion of propofol (Smg/kg/h). 10 patients who received fentanyl-propofol TIVA needed the supplemental fentanyl (0.72±0.37μg/kg/h)in order to maintain a satisfactory anesthesia. The changes of BP and HR during anesthesia were no differences between two groups (P>0.05). The recovery of consciousness and orientation were slower in patients in whom anesthesia was maintained with ketamine-propofol than with fentanyl-propofol (P<0.01). but the periods from anti-muscle relexant administration to extubation were no differences between two groups(P>0.05). There were no emergence delirium during recovery in all patients. It is concluded that propofol can control the side effects of ketamine, and ketamine-propofol TIVA is a proper alternative regimen of general anesthesia.