【罂粟摘要】麻醉诱导期间芬太尼和异丙酚给药间隔时间延长对血流动力学的影响

麻醉诱导可产生严重的异丙酚剂量依赖性低血压。芬太尼的联合使用降低了气管插管时的儿茶酚胺能反应，从而可减少丙泊酚的剂量。本研究的目的是确定通过延长芬太尼与丙泊酚使用之间的时间并减少后者的剂量，是否能改善血流动力学反应，而不增加达到最佳麻醉所需的时间。

在研究伦理委员会批准后，接受非心脏手术与气管插管的患者根据计算机生成的表格随机分为六个时间-剂量组（1或2分钟/1、1.5或2 mg.kg-1的丙泊酚）。排除了气管吸入风险、困难气道、血流动力学不稳定或有麻醉过敏史的患者。各组静脉注射芬太尼（2 µg.kg-1）后，每组在1或2分钟后接受不同剂量的丙泊酚。在诱导前、插管前和插管后测量无创血压（BP）和心率（HR）。麻醉诱导所需时间（双谱指数< 60）也被记录。

在192名招募的患者中，186名完成了研究（1分钟组 n = 94；2分钟组 n = 92）。观察到所有组的HR和BP在给与丙泊酚后下降，而在插管后上升（p < 0.0001）。在55岁以上的患者中，2分钟-2 mg.kg-1组在插管前的收缩压下降最大（36 ± 12%），而1分钟-1.5 mg.kg-1组在插管前后之间的血流动力学变化最小（-4 ± 13%）。在年轻患者中没有发现显著差异，各六组之间达到插管的时间也没有差异。尽管没有记录到严重的心动过缓病例，但样本中有5.4%需要使用升压药。

将芬太尼与丙泊酚的使用间隔延长至两分钟，会导致患者出现更严重的低血压。

原始文献来源：Paula A. Vullo, María I. Real Navacerrada, Ricardo Navarro Suay. Hemodynamic impact of increasing time between fentanyl and propofol administration during anesthesia induction: a randomised, clinical trial.[J]. Critical Care Medicine, 2024, 74 (1): 744230 .

Hemodynamic impact of increasing time between fentanyl and propofol administration during anesthesia induction: a randomised, clinical trial 

Background and objective: Anesthesia induction can produce severe propofol dose-dependenthypotension. Fentanyl coadministration reduces the c atecholaminergic response to orotracheal intubation allowing propofol dose reduction. The aim of this study is to determine whether the hemodynamic response is improved by increasing the time between fentanyl and propofol administration and reducing the dose of the latter without increasing the time to achieve optimal hypnosis.

Methods: After approval by the Research Ethics Committee, patients undergoing non-cardiac surgery with endotracheal intubation were randomized by a computer-generated table into six time-dose groups (1 or 2 minutes/1, 1.5, or 2 mg.kg-1 of propofol). Patients with high bron choaspiration risk, a difficult airway, hemodynamic instability, or anesthetic allergies were excluded. After giving intravenous fentanyl (2 μg.kg-1),  each group received different doses of propofol after 1 or 2 minutes. Non-invasive blood pressure (BP) and heart rate (HR) were mea sured at pre-induction, pre-intubation, and post-intubation. Time to hypnosis (bispectral index < 60) was also recorded.

Results: Of the 192 recruited patients, 186 completed the study (1 min group n = 94; 2 min group n = 92). It was observed that HR and BP decreased after propofol administration and increased after intubation in all groups (p < 0.0001). In patients over 55 years, the 2 min - 2 mg.kg-1 group showed the greatest systolic BP reduction (36 ± 12%) at pre-intubation, while the 1 min - 1.5 mg.kg-1 group showed the least hemodynamic alteration between pre- and postintubation (-4 ± 13%). No significant differences were found in younger patients or in the time to reach hypnosis between the six groups. While no cases of severe bradycardia were recorded, 5,4% of the sample required vasopressors.

Conclusion: Increasing the time between the administration of fentanyl and propofol by up to two minutes results in greater hypotension in patients over 55 years.