A novel mixture of propofol, alfentanil, and lidocaine for regional block with monitored anesthesia care in ophthalmic surgery
A novel mixture of propofol, alfentanil, and lidocaine for regional block with monitored anesthesia care in ophthalmic surgery
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DOI：
10.1016/j.jclinane.2005.08.007
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发表时间：
2006-03-01
影响因子：
6.7
通讯作者：
Keyes, MA
中科院分区：
文献类型：
--
作者：
Fang, ZT;Keyes, MA
研究目的：本研究的目的是确定使用丙泊酚、阿芬太尼和利多卡因混合物进行镇静/镇痛的有效性和安全性。设计：进行回顾性病例分析。设置：本研究在一所大学医学中心进行。患者：89名美国麻醉医师协会的身体状况1，2，和3例成人眼科手术患者进行区域阻滞和监测麻醉护理进行了研究。干预：新鲜混合6 mL丙泊酚、2 mL阿芬太尼和2 mL 2%利多卡因（6-2-2混合物）。根据患者的年龄确定推注剂量：对于75岁以上的患者，5 μ g/kg的阿芬太尼（和0.3 mg/kg的丙泊酚）;年龄每减少10岁，剂量增加1 μ g/kg;对于45岁以下的患者，剂量高达9 μ g/kg的阿芬太尼（0.54 mg/kg的丙泊酚）。在推注完成后1分钟进行区域阻滞。记录了血压（BP）、SaO（2）、心电图、二氧化碳监测、镇静的临床体征、对阻滞的反应、气道支持的需要、恶心和呕吐（N/V）、异丙酚输注引起的疼痛、回忆以及患者和外科医生的满意度。测量和主要结果：78%的患者实现了镇痛和镇静，对阻滞没有不良反应。12%的患者在进针时仅通过眉毛运动实现了良好的镇痛和镇静。27%的人有呼吸抑制，但能够听从命令并保持足够的通风。百分之二的人有短暂的呼吸暂停缓解下巴升降机或下巴推力。镇静前平均收缩压较基础值显著升高（P < 0.0001）。结论：6-2-2混合液的剂量经年龄和体重调整后，可满足大多数患者的镇静要求。由于需要气道支持的发生率低，输注期间没有疼痛，并且没有N/V，这种丙泊酚、阿芬太尼和利多卡因的新型混合物为区域阻滞下的眼科手术提供了足够的镇痛和镇静以及血流动力学稳定性。(c)2006爱思唯尔公司All rights reserved.
Study Objective: The purpose of this study is to determine the efficacy and safety of sedation/analgesia using a mixture of propofol, alfentanil, and lidocame.Design: A retrospective case review was undertaken.Setting: This study took place at a university medical center.Patients: Eighty-nine American Society of Anesthesiologists physical status 1, 2, and 3 adult patients undergoing ophthalmic surgery with regional block and monitored anesthesia care were studied.Intervention: Six milliliters of propofol, 2 mL of alfentanil, and 2 mL of 2% lidocaine (6-2-2 mixture) were freshly mixed. The bolus dose was determined based on the patients' age: 5 mu g/kg of alfentanil (and 0.3 mg/kg of propofol) for patients older than 75 years; the dose increased 1 mu g/kg per 10-year decrease in age; and up to 9 mu g/kg of alfentanil (0.54 mg/kg of propofol) for patients younger than 45 years. Regional block was performed at 1 minute after bolus completion. Blood pressure (BP), SaO(2), electrocardiogram, capnography, clinical signs of sedation, responses to block, need for airway support, nausea and vomiting (N/V), pain due to propofol infusion, recall, and patient and surgeon satisfaction were recorded.Measurements and Main results: Seventy-eight percent of patients achieved analgesia and sedation without adverse response to the block. Twelve percent achieved good analgesia and sedation with only eyebrow movement upon needle insertion. Twenty-seven percent had respiratory depression but were able to follow commands and maintain adequate ventilation. Two percent had brief apnea alleviated by chin lift or jaw thrust. None had pain because of propofol infusion or N/V Before sedation, average systolic BP was significantly increased (P < 0.0001) compared with baseline. After sedation and block, systolic BP decreased 6% from baseline (P < 0.005).Conclusion: Adjusted for age and weight, the dose of the 6-2-2 mixture met the sedation requirements for most patients. With a low incidence of need for airway support, no pain during infusion, and no N/V, this novel mixture of propofol, alfentanil, and lidocaine provided adequate analgesia and sedation as well as hemodynamic stability for ophthalmic Surgery under regional block. (c) 2006 Elsevier Inc. All rights reserved.