在门诊患者中，与等效剂量的芬太尼或舒芬太尼相比，阿芬太尼引起的术后恶心和呕吐更少。

Alfentanil causes less postoperative nausea and vomiting than equipotent doses of fentanyl or sufentanil in outpatients.

作者信息

Langevin S, Lessard M R, Trépanier C A, Baribault J P

机构信息

Department of Anesthesiology, Laval University, Quebec City, Canada.

出版信息

Anesthesiology. 1999 Dec;91(6):1666-73. doi: 10.1097/00000542-199912000-00019.

DOI:10.1097/00000542-199912000-00019

PMID:10598609

Abstract

BACKGROUND

The relative potencies of alfentanil, fentanyl, and sufentanil as a risk factor for postoperative nausea and vomiting have not been determined. They were compared in a randomized study designed to obtain equipotent plasma concentrations of these three opioids at the beginning of the recovery period.

METHODS

The study included 274 patients treated on an outpatient basis. The steady state opioid plasma concentration providing a predicted 50% reduction of the minimum alveolar concentration of isoflurane was used to determine the relative potency of the opioids. The opioids were prepared in equal volumes at concentrations of alfentanil 150 microg/ml, fentanyl 50 microg/ml, and sufentanil 5 microg/ml and were administered in vol/kg. Anesthesia was induced in a blinded fashion with a bolus of the study opioid (0.05 ml/kg) and 4-6 mg/kg thiopental and was maintained with isoflurane (0.6-1%) in a nitrous oxide-oxygen mixture with a continuous infusion of the study opioid (0.06 ml x kg(-1) x h(-1)). If necessary, up to five additional boluses of opioid (0.02 ml/kg) could be given. This opioid administration protocol was tested by pharmacokinetic simulations.

RESULTS

The incidence of postoperative nausea and vomiting was not different in the postanesthesia care unit, but in the ambulatory surgery unit it was significantly lower for alfentanil compared with fentanyl and sufentanil (12, 34, and 35%, respectively P < 0.005). Pharmacokinetic modeling showed that the end-anesthesia opioid plasma concentrations were approximately equipotent in the three groups. However, modeling does not support that the difference between groups in the postoperative period can be explained by a more rapid disappearance of alfentanil from the plasma.

CONCLUSIONS

Alfentanil, compared with approximately equipotent doses of fentanyl and sufentanil, is associated with a lower incidence of postoperative nausea and vomiting in outpatients.

摘要

背景

尚未确定阿芬太尼、芬太尼和舒芬太尼的相对效价作为术后恶心和呕吐的危险因素。在一项随机研究中对它们进行了比较，该研究旨在在恢复期开始时获得这三种阿片类药物的等效血浆浓度。

方法

该研究纳入了274例门诊治疗的患者。使用使异氟烷最低肺泡浓度预计降低50%的稳态阿片类药物血浆浓度来确定阿片类药物的相对效价。将阿片类药物以等体积配制，浓度分别为阿芬太尼150微克/毫升、芬太尼50微克/毫升和舒芬太尼5微克/毫升，并以体积/千克给药。采用盲法，用一剂研究用阿片类药物（0.05毫升/千克）和4 - 6毫克/千克硫喷妥钠诱导麻醉，并用异氟烷（0.6 - 1%）在氧化亚氮 - 氧气混合气体中维持麻醉，同时持续输注研究用阿片类药物（0.06毫升×千克⁻¹×小时⁻¹）。如有必要，可额外给予多达五剂阿片类药物（0.02毫升/千克）。该阿片类药物给药方案通过药代动力学模拟进行了测试。

结果

麻醉后护理单元中术后恶心和呕吐的发生率没有差异，但在门诊手术单元中，与芬太尼和舒芬太尼相比，阿芬太尼的发生率显著更低（分别为12%、34%和35%，P < 0.005）。药代动力学建模显示，三组麻醉结束时的阿片类药物血浆浓度大致等效。然而，建模并不支持术后各组之间的差异可通过阿芬太尼从血浆中更快消失来解释。