Interaction of fentanyl and nitrous oxide on peripheral and cerebral hemodynamics in newborn lambs.
Interaction of fentanyl and nitrous oxide on peripheral and cerebral hemodynamics in newborn lambs.
复制标题
芬太尼和一氧化二氮对新生羔羊外周和脑血流动力学的相互作用。
DOI：
10.1097/00000542-199402000-00016
复制
发表时间：
1994
期刊：
影响因子：
8.8
通讯作者：
Traystman,RJ
中科院分区：
文献类型：
--
作者：
Yaster,M;Koehler,RC;Traystman,RJ
背景阿片类药物能否产生完全的全身麻醉是有争议的。一氧化二氮（N2 O）通常被添加到芬太尼类麻醉剂中，以产生无意识和健忘症。N2 O的加入可能会对芬太尼的血流动力学稳定性和安全性产生不利影响。本研究的目的是确定结合N2 O与芬太尼在新生animals.MethodsThe的生理后果50%的一氧化二氮在氧气（O2），和50%N2O在O2结合3,000微克/公斤芬太尼，对大脑和外周血流动力学的影响进行了研究，在7个未麻醉的新生羔羊，在其中导管先前插入。经过一段时间的控制，羔羊被放置在一个罩，其中吸入的气体浓度得到控制，并尽量减少外部刺激。在呼吸室内空气30分钟后，羔羊再呼吸含50% N2 O的O2 30分钟。然后通过静脉推注和输注（1，000微克）给予羔羊3，000微克/kg芬太尼。kg-1 × h-1）持续60 min，同时继续吸入含50%N2O的O2。结果所有动物在吸入室内空气或单独吸入N2 O时，均对疼痛（夹尾）和声音产生警觉。在N2 O中加入芬太尼可以消除所有对疼痛的反应，但对声音没有影响。此外，芬太尼产生立即呼吸暂停，需要气管插管和机械通气。芬太尼给药、插管和通气后，平均动脉压和心率分别增加27%和23%。在芬太尼输注过程中，它没有变化。脑血流量，O2消耗量和O2输送没有改变时，N2 O单独或与芬太尼联合给药。随着时间的推移，内脏血流量不受处理的影响。芬太尼给药后，肾血流量下降了21%，但不受单独N2 O的影响。右心室和左心室血流量增加（分别为47%和26%）后，芬太尼管理，插管，和通气，但不是当N2 O被管理单独的conclusionsFentanyl（3,000微克/公斤）时，结合50%N2O在O2产生的新生儿羔羊全身麻醉的平面中的疼痛刺激的行为反应被废除。对声音的反应从未消失，脑耗氧量也没有减少。50%N2O的O2、3,000微克/千克芬太尼、气管插管和机械通气的组合并没有降低心率、血压或流向任何主要器官的血流，肾脏除外。
BackgroundThe ability of opioids to produce complete general anesthesia is controversial. Nitrous oxide (N2O) is often added to fentanyl-based anesthetics to produce unconsciousness and amnesia. The addition of N2O may adversely affects fentanyl's hemodynamic stability and safety. The purpose of this study was to determine the physiologic consequences of combining N2O with fentanyl in newborn animals.MethodsThe effects of 50% nitrous oxide in oxygen (O2), and 50% N2O in O2 combined with 3,000 micrograms/kg fentanyl, on cerebral and peripheral hemodynamics were studied in seven unanesthetized newborn lambs, in whom catheters were previously inserted. After a control period, lambs were placed in a hood in which inspired gas concentrations were controlled and which minimized external stimuli. After 30 min of breathing room air, the lambs breathed 50% N2O in O2 for an additional 30 min. The lambs were then given 3,000 micrograms/kg fentanyl by intravenous bolus and by infusion (1,000 micrograms. kg-1 x h-1) for 60 min while continuing to breathe 50% N2O in O2.ResultsAll animals responded to pain (tail clamp) and alerted to sound when breathing room air or when N2O was used alone. Adding fentanyl to the N2O abolished all responses to pain, but not to sound. Additionally, fentanyl produced immediate apnea necessitating tracheal intubation and mechanical ventilation. Mean arterial pressure and heart rate increased 27% and 23%, respectively, after fentanyl administration, intubation, and ventilation. It did not change over the course of the fentanyl infusion. Cerebral blood flow, O2 consumption, and O2 delivery did not change when N2O was administered alone or in combination with fentanyl. Splanchnic blood flow was unaffected by treatment over time. Renal blood flow decreased by 21% after fentanyl administration, but was unaffected by N2O alone. Right and left ventricular blood flow increased (47% and 26%, respectively) after fentanyl administration, intubation, and ventilation, but not when N2O was administered alone.ConclusionsFentanyl (3,000 micrograms/kg) when combined with 50% N2O in O2 produced a plane of general anesthesia in newborn lambs in which the behavioral responses to painful stimuli were abolished. The response to sound was never eliminated, nor was cerebral oxygen consumption decreased. The combination of 50% N2O in O2, 3,000 micrograms/kg fentanyl, tracheal intubation, and mechanical ventilation did not depress heart rate, blood pressure, or blood flow to any of the major organs, except the kidneys.