Rapid inhalation induction of anaesthesia.
Rapid inhalation induction of anaesthesia.
复制标题
快速吸入麻醉诱导。
DOI：
10.1093/bja/61.4.373
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发表时间：
1988
影响因子：
9.8
通讯作者：
G. Drummond
中科院分区：
文献类型：
--
作者：
G. Drummond
374 英国麻醉杂志 刺激，引起反射性呼吸暂停或咳嗽，其次是通气抑制。第一个因素因其在使用氟烷时发生率低而引人注目。在某些情况下，例如静脉注射诱导后，即使是低浓度的氟烷蒸气也可能容易引起咳嗽；然而，大多数志愿者和患者在快速吸入诱导过程中可以轻松吸入 4% 的蒸气。毫无疑问，在传统的吸入诱导中，异氟烷可能比氟烷引起更多的问题；其中大部分是由口咽分泌物引起的 [6, 7] 而不是支气管刺激，更系统地研究这些反应中涉及的不同反射具有相当大的实际意义 [8]。异氟烷因具有刺激性而闻名，这可能阻止了一些研究者使用高浓度的药物 [7]，但对过度刺激和反射性分泌物的担心可能是没有根据的 [4]。使用异氟烷，诱导时间可能与静脉注射药物相当，即使不愿意使用氟烷，吸入技术也可能是可用且可接受的。高浓度的氟烷已被证明具有良好的耐受性；以相同方式使用时，异氟醚可能也具有良好的耐受性。尽管用于快速诱导的 2% 异氟烷比常规使用的异氟烷刺激性较小，但它可能比氟烷更具刺激性 [7]。尚未在未接受药物治疗的受试者中进行使用等位蒸气浓度的比较研究。
374 BRITISH JOURNAL OF ANAESTHESIA irritation, causing reflex apnoea or coughing, and the second is ventilatory depression. The first factor is remarkable for its low incidence when halothane is used. In certain circumstances, such as after an iv induction, even low concentrations of halothane vapour may readily provoke coughing; however, most volunteers and patients may inhale 4% vapour with ease during a rapid inhalation induction. There is no doubt that, in conventional inhalation induction, isoflurane is likely to cause considerably more problems than halothane; most of these result from oropharyngeal secretions [6, 7] rather than bronchial irritation, and it is of considerable practical importance to study more systematically the different reflexes involved in these responses [8]. The reputation that isoflurane has for being pungent may have discouraged some investigators from using high concentrations [7], but the fear of excessive irritation and reflex secretions is possibly unwarranted [4].With isoflurane, induction times may be comparable to those of iv agents, and an inhalation technique may be available and acceptable even if there is reluctance to use halothane. High concentrations of halothane have proved to be tolerated well; it may be that isoflurane could also be tolerated well when used in the same manner. Although 2% isoflurane, used for rapid induction is less irritant than isoflurane used conventionally, it may be more irritant than halothane [7]. A comparative study using equipotent vapour concentrations has not been performed in unpremedicated subjects.