不同剂量芬太尼对地氟醚麻醉诱导的影响

Effects of fentanyl at different doses on anesthesia induction with desflurane

目的观察不同剂量芬太尼对地氟醚麻醉诱导和气管插管最低肺泡有效浓度(MACEI)的影响.方法对56例ASA Ⅰ～Ⅱ级择期手术成人静脉注射芬太尼+吸入地氟醚进行麻醉诱导,随机平均分为4组(A、B、C、D组),各组芬太尼剂量分别为0、2、4和6μg/kg@b.w..记录诱导过程中平均动脉血压(MAP)、心率(HR)变化以及气道刺激情况.根据患者对气管插管的反应,应用“Up-Down”法测定MACEI.结果 A组诱导过程中,随着地氟醚浓度的迅速升高,咳嗽发生率57%、喉痉挛发生率50%,并伴有MAP和HR的显著升高.而B、C、D组很少发生咳嗽和喉痉挛,MAP、HR无显著升高,且MAP和HR峰值显著低于A组.4组病人地氟醚MACEI分别为(1.9±0.3)、(1.1±0.2)、(0.8±0.2)和(0.6±0.2)MAC.与A组比较,其他各组MACEI显著降低(P＜0.05).结论地氟醚麻醉诱导过程中,气道刺激和心血管反应发生率高;预先使用芬太尼2～μg/kg@b.w.能减轻和防止地氟醚引起的气道刺激和心血管反应,并产生地氟醚MACEI剂量依赖性下降.

： Objective To investigate the effects of fentanyl at different doses on anesthesia induction with desflurane and on the latter's minimum alveolar concentration during endotracheal intubation (MACEI). Methods Fifty-six patients (ASA class I-II) were randomly divided into 4 groups (14 in each), and anesthesia was induced in all patients via desflurane inhalation and a bolus injection of fentanyl at 0, 2, 4, and 6 μg/ kg·b.w. respectively in group A, B, C and D. The mean arterial blood pressure (MAP), heart rate (HR) and airway stimulation were recorded during induction. MACEI determination was performed by using up-down method. Results The rapid increase of desflurane concentration resulted in coughing (57%), laryngospasm (50%), and significant increases of MAP and HR in group A during induction. In contrast, coughing and laryngospasm were rare in other groups, and MAP and HR remained stable and their peaks were significantly lower as compared with those in group A. The MACEI of desflurane in group A to D were 1.9±0.3, 1.1±0.2, 0.8±0.2 and 0.6±0.2 MAC respectively, which decreased significantly in group B, C and D compared with that in group A(P<0.05). Conclusion Anesthesia induction with desflurane is associated with a high incidence of airway stimulation and unstable hemodynamics. Fentanyl (2 to 6 μg/ kg·b.w.) helps to eliminate the airway stimulation and cardiovascular response to desflurane, and produces dose-dependent decreases in the MACEI of this anesthetic.