Sá Rêgo M M, Inagaki Y, White P F
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas 75235-9068, USA.
Anesth Analg. 1999 Mar;88(3):518-22. doi: 10.1097/00000539-199903000-00009.
This randomized, double-blind study was designed to evaluate the analgesic effectiveness and respiratory stability of remifentanil when administered as intermittent bolus injections, a variable-rate infusion, or a combination of a constant basal infusion supplemented with intermittent boluses during monitored anesthesia care (MAC). Forty-five patients undergoing extracorporeal shock wave lithotripsy (ESWL) procedures were randomly assigned to one of the three modes of remifentanil administration. All patients received midazolam 2 mg i.v., followed by a propofol infusion at 50 microg x kg(-1) x min(-1). Two minutes before administering a series of test shock waves: Group I received a remifentanil infusion of 0.1 microg x kg(-1) x min(-1), and a saline bolus (5 mL); Group II received a saline infusion and a remifentanil bolus (25 microg in 5 mL); and Group III received a remifentanil infusion of 0.05 microg x kg(-1) x min(-1), and a remifentanil bolus (12.5 microg in 5 mL). The average pain intensity was scored on an 11-point scale, with 0 = no pain to 10 = severe pain. During the ESWL procedure, pain was treated by increasing the study drug infusion rate by 25%-50% and administering 5-mL bolus injections of the study medication in Groups I (saline) and II (remifentanil 25 microg). In Group III, intermittent 5-mL boluses (remifentanil 12.5 microg) were administered as needed. Patients in Groups II and III reported lower pain scores in response to the test shocks. Significantly more remifentanil was administered in Group I (379 +/- 207 microg) than in Group II (201 +/- 136 microg). However, more interventions were required for the treatment of intraoperative pain in the intermittent bolus group (Group II). When remifentanil is administered as the analgesic component of a MAC technique, these data support the use of intermittent bolus doses (12.5-25 microg) alone or in combination with a basal infusion (0.05 microg x kg(-1) x min(-1)) as alternatives to a variable-rate continuous infusion.
In this study, three different modes of remifentanil administration were used during monitored anesthesia care for extracorporeal shock wave lithotripsy procedures. These results suggest that using intermittent bolus injections of remifentanil (25 microg) or a continuous infusion (0.05 microg x kg(-1) x min(-1)) supplemented with intermittent bolus (12.5 microg) injections may be more effective than a variable-rate infusion of remifentanil during propofol sedation.
本随机双盲研究旨在评估瑞芬太尼在监测麻醉护理（MAC）期间以间歇性推注、可变速率输注或持续基础输注加间歇性推注联合使用时的镇痛效果和呼吸稳定性。45例行体外冲击波碎石术（ESWL）的患者被随机分配至瑞芬太尼给药的三种模式之一。所有患者静脉注射咪达唑仑2mg，随后以50μg·kg⁻¹·min⁻¹的速率输注丙泊酚。在给予一系列测试冲击波前两分钟：第一组接受0.1μg·kg⁻¹·min⁻¹的瑞芬太尼输注及生理盐水推注（5mL）；第二组接受生理盐水输注及瑞芬太尼推注（5mL中含25μg）；第三组接受0.05μg·kg⁻¹·min⁻¹的瑞芬太尼输注及瑞芬太尼推注（5mL中含12.5μg）。平均疼痛强度采用11分制评分，0分表示无疼痛，10分表示剧痛。在ESWL手术过程中，第一组（生理盐水）和第二组（瑞芬太尼25μg）通过将研究药物输注速率提高25% - 50%并给予5mL研究药物推注来治疗疼痛。在第三组中，根据需要给予间歇性5mL推注（瑞芬太尼12.5μg）。第二组和第三组患者对测试冲击波的疼痛评分较低。第一组给予的瑞芬太尼（379±207μg）明显多于第二组（201±136μg）。然而，间歇性推注组（第二组）术中疼痛治疗需要更多干预。当瑞芬太尼作为MAC技术的镇痛成分使用时，这些数据支持单独使用间歇性推注剂量（12.5 - 25μg）或与基础输注（0.05μg·kg⁻¹·min⁻¹）联合使用作为可变速率持续输注的替代方法。
在本研究中，体外冲击波碎石术的监测麻醉护理期间使用了三种不同的瑞芬太尼给药模式。这些结果表明，在丙泊酚镇静期间，使用瑞芬太尼间歇性推注（25μg）或持续输注（0.05μg·kg⁻¹·min⁻¹）加间歇性推注（12.5μg）可能比瑞芬太尼可变速率输注更有效。
