CHANGES OF HEMODYNAMICS AND CATECHOLAMINE CONCENTRATIONS AFTER THE ADMINISTRATION OF 1/200,000 EPINEPHRINE IN ELDERLY PATIENTS

本研究旨在探讨局麻溶液中1/200,000肾上腺素对老年患者血流动力学和儿茶酚胺浓度的影响。11例拟行口腔颌面外科手术的患者分为两组；64岁以下患者（组1，N=7）， 65岁以上患者（组2，N= 4）。静脉给予硫喷妥钠或咪达唑仑诱导麻醉，给予维库溴铵促进气管插管。待心血管和呼吸情况稳定后，浸润含0.5%利多卡因的1/20万肾上腺素，测定血液动力学参数及血清中肾上腺素、去甲肾上腺素、多巴胺浓度。1组小鼠在给予利多卡因所含肾上腺素80 ~ 90 s后，收缩压、舒张压及平均血压降低8.1 ~ 10.1%，心率升高9.0%，心输出量升高16.5%，总外周阻力降低9.1%。血中肾上腺素浓度控制值为0.051±0.094 ng/ml， 120秒和300秒后分别升高0.647±0.492和0.640±0.213 ng/ml。去甲肾上腺素和多巴胺浓度无显著变化。2组在给予利多卡因所含肾上腺素110 ~ 140 s后，收缩压、舒张压及平均血压降低7.6 ~ 8.6%，心率升高6.0%，心输出量升高14.9%，总外周阻力降低17.9%。血中肾上腺素浓度控制值为0.018±0.012 ng/ml， 120秒和300秒后分别升高0.094±0.035和0.173±0.079 ng/ml。去甲肾上腺素和多巴胺浓度未见明显变化。

The purpose of the present study was to investigate the changes of hemodynamics and catecholamine concentrations after the administration of 1/200,000 epinephrine contained in local anesthetic solution in elderly patients. Eleven patients scheduled for oral and maxillofacial surgery were divided into two groups; the patients under 64 years old (group 1, N=7) and over 65 years old (group 2, n=4). Anesthesia was induced with the intravenous administration of thiopental or midazolam, and tracheal intubation was facilitated with the administration of vecuronium. After cardiovascular and respiratory conditions were stabilized, 1/200,000 epinephrine contained in 0.5% lidocaine was infiltrated, then the hemodynamic parameters and the serum concentrations of epinephrine, norepinephrine, and dopamine were measured.In the group 1, systolic, diastolic and mean blood pressure were reduced by 8.1〜10.1%, heart rate increased by 9.0%, cardiac output increased by 16.5%, total peripheral resistance was lowered by 9.1% 80〜90 seconds after the administration of epinephrine contained in lidocaine. The control value of epinephrine concentration in blood was 0.051±0.094 ng/ml, but increased 0.647±0.492 and 0.640±0.213 ng/ml after 120 and 300 seconds, respectively. Norepinephrine and dopamine concentrations did not change significantly.In the group 2, systolic, diastolic and mean blood pressure were reduced by 7.6〜8.6%, heart rate increased by 6.0%, cardiac output increased by 14.9%, total peripheral resistance was lowered by 17.9% 110〜140 seconds after the administration of epinephrine contained in lidocaine. The control value of epinephrine concentration in blood was 0.018±0.012 ng/ml, but increased 0.094±0.035 and 0.173±0.079 ng/ml after 120 and 300 seconds, respectively. No significant changes in norepinephrine and dopamine concentrations were observed.