终末期肾衰竭患者使用瑞芬太尼、丙泊酚和顺式阿曲库铵的全静脉麻醉

Total intravenous anesthesia with remifentanil, propofol and cisatracurium in end-stage renal failure.

作者信息

Dahaba A A, von Klobucar F, Rehak P H, List W F

机构信息

Department of Anesthesiology and Intensive Care Medicine, Karl-Franzens University, Graz, Austria.

出版信息

Can J Anaesth. 1999 Jul;46(7):696-700. doi: 10.1007/BF03013962.

DOI:10.1007/BF03013962

PMID:10442969

Abstract

PURPOSE

To compare recovery parameters of total intravenous anesthesia (TIVA) with remifentanil and propofol, hemodynamic responses to perioperative events, and pharmacodynamic parameters of cisatracurium in 22 end-stage renal failure and 22 normal renal function patients.

METHODS

Anesthesia was induced with 2-3 mg x kg(-1) propofol and 1 microg x kg(-1) remifentanil and maintained with 75 microg x kg(-1) x min(-1) propofol and propofol initial infusion of 0.2 microg x kg(-1) x min(-1) propofol. Arterial pressure and heart rate were maintained by remifentanil infusion rate adjustments. The first twitch (T1) was maintained at 25% by an infusion of cisatracurium.

RESULTS

There was no difference in the time to maintenance of adequate respiration, date of birth recollection, first analgesic administration, between the renal failure (4.8+/-2.5, 7.8+/-3.2, 12.3+/-5.3 min respectively) and the control group (5.2+/-2.8, 8.1+/-3.1, 12.7+/-5.5 min): nor were there any differences in the time to 25% T1 recovery, T1 recovery from 25% to 75%, or cisatracurium infusion rate between the renal failure group (32.1 +/-10.8 min, 18.2+/-5.5 min, 0.89+/-0.29 microg x kg(-1) min(-1) respectively) and the control group (35.9 (7.9 min, 18.4+/-3.8 min, 0.95+/-0.22 microg x kg(-1) x min(-1)).

CONCLUSION

End-stage renal failure does not prolong recovery from TIVA with remifentanil and propofol, or the recovery from cisatracurium neuromuscular block.

摘要

目的

比较22例终末期肾衰竭患者和22例肾功能正常患者在使用瑞芬太尼和丙泊酚进行全静脉麻醉（TIVA）时的恢复参数、围手术期事件的血流动力学反应以及顺式阿曲库铵的药效学参数。

方法

用2 - 3mg·kg⁻¹丙泊酚和1μg·kg⁻¹瑞芬太尼诱导麻醉，并用75μg·kg⁻¹·min⁻¹丙泊酚维持，丙泊酚初始输注速率为0.2μg·kg⁻¹·min⁻¹。通过调整瑞芬太尼输注速率维持动脉压和心率。通过输注顺式阿曲库铵将第一个肌颤搐（T1）维持在25%。

结果

肾衰竭组（分别为4.8±2.5、7.8±3.2、12.3±5.3分钟）和对照组（5.2±2.8、8.1±3.1、12.7±5.5分钟）在维持充分呼吸的时间、出生日期回忆、首次给予镇痛药方面无差异；肾衰竭组（分别为32.1±10.8分钟、18.2±5.5分钟、0.89±0.29μg·kg⁻¹·min⁻¹）和对照组（35.9±7.9分钟、18.4±3.8分钟、0.95±0.22μg·kg⁻¹·min⁻¹）在T1恢复至25%的时间、T1从25%恢复至75%的时间或顺式阿曲库铵输注速率方面也无差异。