Interaction of Propofol and Sevoflurane on Loss of Consciousness and Movement to Skin Incision during General Anesthesia
Interaction of Propofol and Sevoflurane on Loss of Consciousness and Movement to Skin Incision during General Anesthesia
复制标题
异丙酚和七氟醚对全身麻醉期间皮肤切口意识丧失和运动的相互作用
作者：
Robert S. Harris;Olga Lazar;J. Johansen;P. Sebel
背景：意识丧失（LOC）和手术切口不动似乎是由中枢神经系统的不同水平介导的。催眠药物的药理学研究以前集中在挥发性或静脉麻醉药的组合上。本研究考察了吸入七氟醚和静脉注射异丙酚在这两个临床相关麻醉终点的联合应用。方法：初步纳入36例择期手术患者。得到了七氟醚和靶控异丙酚输注的近似稳态条件。患者依次评估LOC（大声加轻度刺激）和手术切口不动。本研究采用Dixon上下法设计。结果：异丙酚加七氟醚（尾潮浓度0.46%）的效果目标为1.2；G /ml（95%置信区间1.1-1.3 μ G /ml）。与用简单相加法预测的结果（95%置信区间为1.2 ~ 1.7 μ g/ml）无显著差异。50%患者抑制皮肤切口运动的异丙酚有效血药浓度为5.4；G /ml（95%可信区间，4.8 ~ 6.0 G /ml）加七氟醚（0.86%），与可加性预测值（5.4 G /ml， 95%可信区间，4.8 ~ 5.9 G /ml）无显著差异。两种分析都有足够的能力（90%）检测到预测值的显著变化（±19%至25%）。重复测量方差分析确定了双谱指数值70作为在LOC有反应或没有反应的人之间的断点。结论：异丙酚和七氟醚以简单的加性方式相互作用，产生手术切口LOC和不动，提示其作用机制相同或作用部位单一。这些临床观察结果与单一部位的相互作用是一致的。-氨基丁酸A型受体。
Background:Loss of consciousness (LOC) and immobility to surgical incision seem to be mediated at different levels of the central nervous system. Pharmacologic studies of hypnotic agents have previously focused on combinations of either volatile or intravenous anesthetics. This study examined the combination of inhaled sevoflurane and intravenous propofol at these two clinically relevant anesthetic end points. Methods:Thirty-six elective surgical patients were initially enrolled. Conditions approximating steady state were obtained for sevoflurane and target-controlled propofol infusions. Patients were sequentially evaluated for LOC (loud voice plus mild prodding) and immobility to surgical incision. The study was designed using the Dixon up–down method. Results:The observed propofol effect target with 50% response plus sevoflurane (0.46% end-tidal concentration) was 1.2 &mgr;g/ml (95% confidence interval, 1.1–1.3 &mgr;g/ml). It was not significantly different from that predicted (1.5 &mgr;g/ml; 95% confidence interval, 1.2–1.7 &mgr;g/ml) by simple additivity. The effective plasma concentration of propofol that suppressed movement to skin incision in 50% of patients was 5.4 &mgr;g/ml (95% confidence interval, 4.8–6.0 &mgr;g/ml) plus sevoflurane (0.86%) and was not significantly different from that predicted by additivity (5.4 &mgr;g/ml; 95% confidence interval, 4.8–5.9 &mgr;g/ml). Both analyses had adequate power (90%) to detect a significant change (±19 to 25%) from predicted value. Repeated-measures analysis of variance identified a Bispectral Index value of 70 as the break point between those who responded at LOC or did not. Conclusions:Propofol and sevoflurane interact in a simple additive manner to produce LOC and immobility to surgical incision, suggesting a common mechanism or a single site of action. These clinical observations are consistent with a single site of interaction at the &ggr;-aminobutyric acid type A receptor.
手术患者异丙酚-硫喷妥钠催眠相互作用的等辐射线分析。
影响因子：
5.7
作者：
Vinik,HR;BradleyJr,EL;Kissin,I
通讯作者：
Kissin,I