丙泊酚和瑞芬太尼用于择期非心脏手术的全静脉麻醉。

Total intravenous anesthesia with propofol and remifentanil for elective non-cardiac surgery.

作者信息

Pelosi G, Gratarola A, Pissaia C, Mendola C, Bellomo G

机构信息

Department of Anesthesiology and Intensive Care, University of Eastern Piedmont School of Medicine, Novara.

出版信息

Minerva Anestesiol. 1999 Nov;65(11):791-8.

PMID:10634052

Abstract

BACKGROUND

Remifentanil is a highly effective mu opioid agonist with predictable pharmacokinetics and a close concentration-effect relationship. Moreover, studies on anesthetic drugs interactions show that optimal propofol concentrations decrease more significantly with remifentanil as compared with other opioids and recovery appears to be much faster than when propofol is combined with other opioids combinations. This intervention study was designed to evaluate the efficacy of propofol combined with remifentanil in elective non cardiac inpatient surgery.

METHODS

N. 405 patients undergoing intraperitoneal, head-neck, intrathoracic, major orthopaedics, breast and major vascular surgery received: remifentanil (1 microgram.kg-1 at induction; 0.50 microgram.kg-1.min-1 at laryngoscopy; 0.25 microgram.kg-1.min-1 at skin incision; 0.25-0.30 microgram.kg-1.min1 from skin incision to end of skin suture) and propofol (0.5-1 mg.kg-1 at induction; 5 mg.kg-1.h-1 at laryngoscopy; 5 mg.kg-1.h-1 at skin incision and 5 mg.kg1.h1 thereafter). Intraoperative end-points included somatic responses, tachycardia and hypertension to laryngoscopy and surgery. Incidence of intraoperative bradycardia, hypotension and muscle rigidity were also recorded. Postoperative end-points included Aldrete score > or = 9, pain immediately following emergence and PONV.

RESULTS

Propofol-remifentanil combination effectively controlled responses to laryngoscopy and surgical stress. Drug related adverse events were transient bradycardia (< 50 bpm) and hypotension (SBP < or = 80 mmHg) respectively: at prelaryngoscopy 11.60-1.48% and at pre-skin incision 10.61-0.98%. N. 365 patients were discharged from PACU and the median time to first Aldrete score > or = 9 was 22.3 min. The most frequent postoperative event was shivering recorded in n. 46 patients (12%). Postoperative analgesic medication was requested by n. 16 patients (4.4%) and PONV was noted in n. 6 patients (1.6%).

CONCLUSIONS

When combined with propofol, remifentanil effectively provided for profound analgesia during surgery, stable anesthetic conditions, simplicity of use and predictable recovery.

摘要

背景

瑞芬太尼是一种高效的μ阿片受体激动剂，其药代动力学可预测，且浓度-效应关系密切。此外，关于麻醉药物相互作用的研究表明，与其他阿片类药物相比，瑞芬太尼存在时，最佳丙泊酚浓度下降更为显著，且恢复似乎比丙泊酚与其他阿片类药物联合使用时要快得多。本干预性研究旨在评估丙泊酚联合瑞芬太尼用于择期非心脏住院手术的疗效。

方法

405例接受腹腔、头颈、胸腔、大型骨科、乳腺及大血管手术的患者接受以下处理：瑞芬太尼（诱导时1μg·kg-1；喉镜检查时0.50μg·kg-1·min-1；皮肤切开时0.25μg·kg-1·min-1；从皮肤切开至皮肤缝合结束时0.25 - 0.30μg·kg-1·min-1）和丙泊酚（诱导时0.5 - 1mg·kg-1；喉镜检查时5mg·kg-1·h-1；皮肤切开时5mg·kg-1·h-1，此后5mg·kg-1·h-1）。术中观察指标包括对喉镜检查和手术的躯体反应、心动过速及高血压。还记录术中心动过缓、低血压及肌肉强直的发生率。术后观察指标包括Aldrete评分≥9分、苏醒后即刻疼痛及术后恶心呕吐（PONV）。

结果

丙泊酚-瑞芬太尼联合用药有效控制了对喉镜检查和手术应激的反应。与药物相关的不良事件分别为短暂性心动过缓（<50次/分钟）和低血压（收缩压≤80mmHg）：喉镜检查前发生率为11.60 - 1.48%，皮肤切开前发生率为10.61 - 0.98%。365例患者从麻醉后恢复室出院，首次Aldrete评分≥9分的中位时间为22.3分钟。最常见的术后事件是46例患者（12%）出现寒战。16例患者（4.4%）需要术后镇痛药物，6例患者（1.6%）出现PONV。