Coles J P, Leary T S, Monteiro J N, Brazier P, Summors A, Doyle P, Matta B F, Gupta A K
Department of Anesthesia, Addenbrooke's Hospital, Cambridge, England.
J Neurosurg Anesthesiol. 2000 Jan;12(1):15-20. doi: 10.1097/00008506-200001000-00004.
For patients undergoing craniotomy, it is desirable to have stable and easily controllable hemodynamics during intense surgical stimulation. However, rapid postoperative recovery is essential to assess neurologic function. Remifentanil, an ultra-short-acting mu-opioid receptor agonist, may be the ideal agent to confer the above characteristics. In this prospective randomized study, we compared the hemodynamic stability, recovery characteristics, and the dose of propofol required for maintaining anesthesia supplemented with an infusion of remifentanil, alfentanil, or fentanyl in 34 patients scheduled for supratentorial craniotomy. With routine monitors in place, anesthesia was induced with propofol (2-3 mg/kg), atracurium (0.5 mg/kg), and either remifentanil (1 microg/kg), alfentanil (10 microg/kg), or fentanyl (2 micro/kg). The lungs were ventilated with O2/air to mild hypocapnia. Anesthesia was maintained with infusions of propofol (50-100 microg/kg/min) and either remifentanil (0.2 microg/kg/min), alfentanil (20 microg/kg/h), or fentanyl (2 microg/kg/h). There were no significant differences among the groups in the dose of propofol maintenance required, heart rate, or mean arterial pressure. However, the time to eye opening (minutes) was significantly shorter in the remifentanil compared to the alfentanil group (6+/-3; 21+/-14; P = 0.0027) but not the fentanyl group (15+/-9). We conclude that remifentanil is an appropriate opioid to use in combination with propofol during anesthesia for supratentorial craniotomy.
对于接受开颅手术的患者，在强烈的手术刺激期间，保持稳定且易于控制的血流动力学是很理想的。然而，术后快速恢复对于评估神经功能至关重要。瑞芬太尼是一种超短效的μ阿片受体激动剂，可能是具备上述特性的理想药物。在这项前瞻性随机研究中，我们比较了34例计划行幕上开颅手术患者在输注瑞芬太尼、阿芬太尼或芬太尼辅助麻醉时的血流动力学稳定性、恢复特性以及维持麻醉所需丙泊酚的剂量。在常规监测下，用丙泊酚（2 - 3mg/kg）、阿曲库铵（0.5mg/kg）以及瑞芬太尼（1μg/kg）、阿芬太尼（10μg/kg）或芬太尼（2μg/kg）诱导麻醉。用氧气/空气进行肺通气使患者处于轻度低碳酸血症状态。用丙泊酚输注（50 - 100μg/kg/min）以及瑞芬太尼（0.2μg/kg/min）、阿芬太尼（20μg/kg/h）或芬太尼（2μg/kg/h）维持麻醉。各组在维持麻醉所需丙泊酚剂量、心率或平均动脉压方面无显著差异。然而，与阿芬太尼组相比，瑞芬太尼组睁眼时间（分钟）显著缩短（6±3；21±14；P = ＜0.0027），但与芬太尼组相比无显著差异（15±9）。我们得出结论，瑞芬太尼是幕上开颅手术麻醉期间与丙泊酚联合使用的合适阿片类药物。
