한국임상수의학회지 (Journal of Veterinary Clinics)

  • 제32권6호
  • /
  • Pages.491-498
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  • 2015
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  • 1598-298X(pISSN)
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  • 2384-0749(eISSN)
한국임상수의학회 (The Korean Society of Veterinary Clinics)
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개에서 Remifentanil과 Propofol에 의한 완전 정맥 내 마취 시 Doxapram 투여가 심폐기능에 미치는 효과

The Effect of Doxapram on Cardiopulmonary Function in Dogs under Total Intravenous Anesthesia with Remifentanil and Propofol

  • Yun, Sungho (Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University) ;
  • Kwon, Youngsam (Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University)
  • 심사 : 2015.11.19
  • 발행 : 2015.12.31
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초록

개에서 remifentanil과 propofol을 사용한 완전 정맥내 마취에서 doxapram의 점적투여가 심폐기능에 미치는 영향에 대해 평가해 보았다. 수컷 비글견 15마리를 사용하였으며 무작위로 5마리씩 3군으로 나누었다. 모든 군에서 전 마취제로 medetomidine을 $20{\mu}g/kg$ 정맥주사 하였고 remifentanil과 propofol의 점적 투여로 1시간 30분 동안 마취하였다. 마취 시작 시, 각 그룹 별로 지정된 용량의 doxapram을 병용 투여하였다. D1 군은 doxapram 0.25 mg/kg을 투여한 후 $8.33{\mu}g/kg/min$의 속도로 점적 투여했다. D2 군은 doxapram 2 mg/kg을 투여한 후 $66.66{\mu}g/kg/min$의 속도로 점적 투여했다. 대조군은 생리 식염수를 투여하였다. 외과적 마취기를 평가하고, 혈액 가스 분석, 호흡수, 심박수, 동맥혈압을 측정하였으며 마취회복기 동안의 행동변화를 관찰 기록하였다. 외과적 마취기는 마취기 전반에 걸쳐 모든 군에서 잘 유지되었다. 대조군에 비해 D2 군에서 호흡수의 유의적인 상승이 있었으며 (p < 0.05), 동맥혈 산소 분압과 산소 포화도에서는 doxapram 처치군 모두에서 대조군에 비해 유의적인 상승을 보였다(p < 0.05). 동맥혈 이산화탄소 분압은 고농도 처치 군인 D2군에서 유의적인 감소를보였다(p < 0.05). 수축기 동맥혈압, 이완기 동맥혈압, 평균 동맥혈압은 D2군에서 유의적인 증가를 보였다. 심박수와 pH는 유의적인 변화가 관찰되지 않았다. 따라서 본 실험을 통해 개에서 remifentanil과 propofol을 사용한 완전 정맥내 마취에서 일어날 수 있는 저산소증이나 저혈압과 같은 심폐 기능 저하를 doxapram의 점적 투여가 진통 작용에 경감 없이 완화 시키는 것을 알 수 있었다.

We investigated the effect of constant rate infusion (CRI) with doxapram on cardiopulmonary function during total intravenous anesthesia (TIVA) with remifentanil and propofol CRI in dogs. Fifteen male Beagle dogs were randomly divided into 3 groups. All groups were premedicated with medetomidine ($20{\mu}g/kg$, IV) and anesthetized by remifentanil/propofol CRI for one and half hour. At the initiating of the anesthesia, different doses of doxapram for each group were administrated as the followings; D1 group - doxapram 0.25 mg/kg bolus followed by doxapram $8.33{\mu}g/kg/min$, D2 group - doxapram 2 mg/kg bolus followed by doxapram $66.66{\mu}g/kg/min$, control group - normal saline. The anesthetic depth for surgery was well maintained in all groups throughout the anesthetic periods. The respiratory rate was significantly higher in D2 group than that of control group (p < 0.05). The values of $PaO_2$ and $SaO_2$ were significantly increased in both D1 and D2 groups compared with control group (p < 0.05). High dose of doxapram (D2 group) significantly decreased the level of $PaCO_2$ compared with control group (p < 0.05). The values of systolic, mean and diastolic arterial pressure were significantly increased in doxapram 2 group (p < 0.05). There were no significant differences in the values of heart rate and pH of arterial blood. Therefore, doxapram CRI may be useful to alleviate the suppression of cardiopulmonary function including hypoxia and hypotension during TIVA with remifentanil and propofol in dogs.

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참고문헌

  1. Anderson-Beck R, Wilson L, Brazier S, Hughes IE, Peers C. Doxapram stimulates dopamine release from the intact rat carotid body in vitro. Neurosci Lett 1995; 187: 25-28. https://doi.org/10.1016/0304-3940(95)11328-T
  2. Baxter AD. Side effects of doxapram infusion. Eur J Intensive Care Med 1976; 2: 87-88. https://doi.org/10.1007/BF01886121
  3. Bruce RB, Pitts JE, Pinchbeck F, Newman J. Excretion, Distribution, and Metabolism of Doxapram Hydrochloride. J Med Chem 1965; 8: 157-164. https://doi.org/10.1021/jm00326a004
  4. Chism JP, Rickert DE. The pharmacokinetics and extra-hepatic clearance of remifentanil, a short acting opioid agonist, in male beagle dogs during constant rate infusions. Drug Metab Dispos 1996; 24: 34-40.
  5. Feldman PL, James MK, Brackeen MF, Bilotta JM, Schuster SV, Lahey AP, Lutz MW, Johnson MR, Leighton HJ. Design, synthesis, and pharmacological evaluation of ultrashort- to long-acting opioid analgetics. J Med Chem 1991; 34: 2202-2208. https://doi.org/10.1021/jm00111a041
  6. Gairola RL, Gupta PK, Pandley K. Antagonists of morphineinduced respiratory depression. A study in postoperative patients. Anaesthesia 1980; 35: 17-21. https://doi.org/10.1111/j.1365-2044.1980.tb03714.x
  7. Glowaski MM, Wetmore LA. Propofol: application in veterinary sedation and anesthesia. Clin Tech Small Anim Pract 1999; 14: 1-9. https://doi.org/10.1016/S1096-2867(99)80021-8
  8. Gozdemir M, Sert H, Yilmaz N, Kanbak O, Usta B, Demircioglu RI. Remifentanil-propofol in vertebral disk operations: hemodynamics and recovery versus desfluranen( 2)o inhalation anesthesia. Adv Ther 2007; 24: 622-631. https://doi.org/10.1007/BF02848787
  9. Hirsh K, Wang SC. Selective respiratory stimulating action of doxapram compared to pentylenetetrazaol. J Pharmacol Exp Ther 1974; 189: 1-11.
  10. Joshi GP, Warner DS, Twersky RS, Fleisher LA. A comparison of the remifentanil and fentanyl adverse effect profile in a multicenter phase IV study. J Clin Anesth 2002; 14: 494-499. https://doi.org/10.1016/S0952-8180(02)00404-X
  11. Mertens MJ, Olofsen E, Engbers FH, Burm AG, Bovill JG, Vuyk J. Propofol reduces perioperative remifentanil requirements in a synergistic manner: response surface modeling of perioperative remifentanil-propofol interactions. Anesthesiology 2003; 99: 347-359. https://doi.org/10.1097/00000542-200308000-00016
  12. Moerman AT, Struys MM, Vereecke HE, Herregods LL, De Vos MM, Mortier EP. Remifentanil used to supplement propofol does not improve quality of sedation during spontaneous respiration. J Clin Anesth 2004; 16: 237-243. https://doi.org/10.1016/j.jclinane.2003.08.005
  13. Muir WW 3rd, Gadawski JE. Respiratory depression and apnea induced by propofol in dogs. Am J Vet Res 1998; 59: 157-161.
  14. Murrell JC, van Notten RW, Hellebrekers LJ. Clinical investigation of remifentanil and propofol for the total intravenous anaesthesia of dogs. Vet Rec 2005; 156: 804-808. https://doi.org/10.1136/vr.156.25.804
  15. Nieuwenhuijs DJ, Olofsen E, Romberg RR, Sarton E, Ward D, Engbers F, Vuyk J, Mooren R, Teppema LJ, Dahan A. Response surface modeling of remifentanil-propofol interaction on cardiorespiratory control and bispectral index. Anesthesiology 2003; 98: 312-322. https://doi.org/10.1097/00000542-200302000-00008
  16. O'Hare RA, Mirakhur RK, Reid JE, Breslin DS, Hayes A. Recovery from propofol anaesthesia supplemented with remifentanil. Br J Anaesth 2001; 86: 361-365. https://doi.org/10.1093/bja/86.3.361
  17. Oddby E, Englund S, Lonnqvist PA. Postoperative nausea and vomiting in paediatric ambulatory surgery: sevoflurane versus spinal anaesthesia with propofol sedation. Paediatr Anaesth 2001; 11: 337-342. https://doi.org/10.1046/j.1460-9592.2001.00670.x
  18. Ozkan S, Cingozbay BY, Usyilmaz S, Cankir Z, Cebeci BS, Gokben M. Comparison of hemodynamic and neuroendocrine changes during total intravenous anesthesia and inhalation anesthesia. Curr Ther Res Clin Exp 2001; 62: 142-152. https://doi.org/10.1016/S0011-393X(01)80023-0
  19. Pagel PS, Warltier DC. Negative inotropic effects of propofol as evaluated by the regional preload recruitable stroke work relationship in chronically instrumented dogs. Anesthesiology 1993; 78: 100-108. https://doi.org/10.1097/00000542-199301000-00015
  20. Peacock JE, Luntley JB, O'Connor B, Reilly CS, Ogg TW, Watson BJ, Shaikh S. Remifentanil in combination with propofol for spontaneous ventilation anaesthesia. Br J Anaesth 1998; 80: 509-511. https://doi.org/10.1093/bja/80.4.509
  21. Poets CF, Darraj S, Bohnhorst B. Effect of doxapram on episodes of apnoea, bradycardia and hypoxaemia in preterm infants. Biol Neonate 1999; 76: 207-213. https://doi.org/10.1159/000014160
  22. Rosenberg J, Kristensen PA, Pedersen MH, Overgaard H. Adverse events with continuous doxapram infusion against late postoperative hypoxaemia. Eur J Clin Pharmacol 1996; 50: 191-194. https://doi.org/10.1007/s002280050091
  23. Shafer SL, Varvel JR. Pharmacokinetics, pharmacodynamics, and rational opioid selection. Anesthesiology 1991; 74: 53-63. https://doi.org/10.1097/00000542-199101000-00010
  24. Smith I, White PF, Nathanson M, Gouldson R. Propofol. An update on its clinical use. Anesthesiology 1994; 81: 1005-1043. https://doi.org/10.1097/00000542-199410000-00028
  25. Wu CC, Mok MS, Chen JY, Wu GJ, Wen YR, Lin CS. Doxapram shortens recovery following sevoflurane anesthesia. Can J Anaesth 2006; 53: 456-460. https://doi.org/10.1007/BF03022617
  26. Yost CS. A new look at the respiratory stimulant Doxapram. CNS Drug Rev 2006; 12: 236-249. https://doi.org/10.1111/j.1527-3458.2006.00236.x