Intravenous Infusion of Low Dose Propofol for Conscious Sedation in Cesarean Section before Spinal Anesthesia

剖腹產脊髓麻醉前以低劑量Propofol靜脈連續注射作清醒鎮靜

鄭雅蓉(Ya-Jung Cheng) ； 王永彬(Yong-Ping Wang) ； 范守仁(Shou-Zen Fan) ； 劉健強(Chien-Chiang Liu)

《Acta Anaesthesiologica Sinica》 35卷2期 (1997/06) Pp. 79-84

摘要

Background: Conscious sedation, not affecting the safety of both mother and fetus, is especially favorable in anxious patients undergoing Cesarean delivery. However, when sedation is started before performing intrathecal anesthesia, the infusion time before delivery will be prolonged. In this study, the incidence of maternal and fetal complications under propofol infusion were evaluated as well as the blood concentrations of propofol during delivery at different time of sedation. Methods: Maternal and fetal effects of pre-spinal sedation with low dose propofol infusion technique (3 mg/kg/h following 0.3 mg/kg bolus) in 37 Cesarean paturients were evaluated, compared with another 33 paturients under spinal anesthesia without any sedatives. Results: The induction to delivery time was 32.6 ± 7.7 min. Satisfactory, airway-maintaining conscious sedation was shown without increasing the incidence of post-spinal hypotension and hypoxemia compared with non-sedative group. The plasma propofol concentrations in the mean time of delivery in maternal vein and umbilical vein were 0.86 ± 0.29 and 0.33 ± 0.11 μg/ml, respectively. Umbilical venous concentration neither correlated with infusion time nor exceeded the maternal venous concentration. The 1-min and 5-min Apgar scores as well as umbilical venous blood gas analyses did not differ significantly between two groups. Conclusions: Conscious sedation by low dose propofol infusion is safe for both mother and fetus in spite of longer infusion time.

關鍵字

Anesthesia: obstetric ； Delivery: Cesarean section ； Sedatives, nonbarbiturate: propofol

並列摘要

背景：清醒鎮靜（conscious sedation）對解除剖腹產病人之焦慮、呼吸道之維護和保存生產經驗，較重度鎮靜為適當。依過去之文獻報告顯示，propofol靜脈灌注可提供區域麻醉病人良好之鎮靜。雖然propofol曾安全地用於剖腹產之全身麻醉誘導，但以低劑量持續靜脈灌注施行麻醉前及麻醉中鎮靜，對母親及胎兒之影響則尚待評估。方法：本實驗以兩組剖腹產之病人，一組在脊髓麻醉前接受低劑量propofol灌注（先靜脈注射0.3 mg/kg，然後滴注3 mg/kg/h），另一組則未接受任何藥物，除比較母親接受麻醉後血行動力學之變化和鎮靜效果及生產經驗之維持以外，並比較胎兒之APGAR分數及臍血血氧等分析。母親及胎兒在娩生時之propofol濃度也以氣體色層分析法測量，以瞭解持續灌注之胎盤穿透。結果：分娩前平均灌注時間為32.6±7.7分鐘。此方法可提供滿意的鎮靜效果，病人較平靜、合作並可保持言語反應及呼吸道暢通。兩組病人麻醉後之變化和嬰兒之評估並無差別。娩出時母親及胎兒之propofol血漿濃度分別為0.86±0.29和0.33±0.11μg/ml，並且和灌注時間長短無關。結論：低劑量propofol靜脈灌注用於剖腹產麻醉前之清醒鎮靜，對母親和胎兒均能維持相當之安全度，而灌注時間並不增加胎兒血漿之藥物濃度。

並列關鍵字

麻醉：產科 ； 生產：剖腹產 ； 鎮靜劑，非巴比妥鹽：propofol