Han T, Kim D, Kil H, Inagaki Y
Department of Anesthesiology, Samsung Medical Center, SungKyunKwon University School of Medicine, Seoul, Korea.
Anesth Analg. 2000 Jun;90(6):1365-71. doi: 10.1097/00000539-200006000-00019.
To determine the effects of plasma fentanyl concentrations on intraoperative propofol requirements, emergence from anesthesia, and relief of postoperative pain, we studied 60 ASA physical status I and II patients undergoing spine fusion. The patients were randomly assigned to four study groups according to the expected intraoperative plasma fentanyl concentrations. Group I received an infusion of saline, and Groups II, III, and IV received fentanyl infusions to maintain the blood levels at 1.5, 3.0, and 4.5 ng/mL, respectively. An infusion rate of propofol was adjusted to keep the mean arterial pressure within 15% of the control value. Inspired nitrous oxide concentrations were maintained at 67%. The following were investigated in each group: 1) an average propofol infusion rate, 2) time to spontaneous eye opening and recovery of orientation (name, date, and place), and 3) total dose of fentanyl used for 24 h after admission to the postanesthetic care unit. Average propofol infusion rates were 10.1 +/- 2.5 (mean +/- SD), 7.5 +/- 1.2, 5.7 +/- 1.1, and 4.9 +/- 1.2 mg. kg(-1). h(-1), in Groups I, II, III, and IV, respectively. Groups receiving fentanyl infusion had significantly smaller infusion rates of propofol (P < 0.01) than the group receiving saline. Among the three fentanyl infusion groups, Group II (P < 0.01) had more than Groups III and IV. The time to spontaneous eye opening and the recovery of orientation were directly related to plasma fentanyl concentrations. The plasma fentanyl levels between Groups III and IV were the same. The total amount of IV patient-controlled analgesia fentanyl during postoperative 24 h increased significantly when the order of plasma fentanyl concentrations was reversed, 913.1 +/- 58.4, 553.4 +/- 129, 222.7 +/- 73.4, and 135.1 +/- 69.5 microg in Groups I, II, III, and IV, respectively. These results suggest that the addition of fentanyl infusions had ceiling effects that reduce the intraoperative propofol requirements according to the plasma fentanyl concentrations. The ceiling effect was demonstrated in the recovery of consciousness but not in the fentanyl requirements for postoperative analgesia.
The addition of fentanyl, a potent opioid, reduced the intraoperative requirement of propofol, an IV anesthetic, in the order of the plasma fentanyl concentrations. The ceiling effects of fentanyl were demonstrated in the reduction of propofol requirements and recovery of consciousness but not in the fentanyl requirements for postoperative analgesia.
为了确定血浆芬太尼浓度对术中丙泊酚需求量、麻醉苏醒及术后疼痛缓解的影响，我们研究了60例接受脊柱融合术的美国麻醉医师协会（ASA）身体状况分级为Ⅰ级和Ⅱ级的患者。根据预期的术中血浆芬太尼浓度，将患者随机分为四个研究组。Ⅰ组输注生理盐水，Ⅱ组、Ⅲ组和Ⅳ组分别输注芬太尼以维持血药浓度在1.5、3.0和4.5 ng/mL。调整丙泊酚输注速率以使平均动脉压维持在对照值的15%以内。吸入氧化亚氮浓度维持在67%。对每组进行以下指标的研究：1）丙泊酚平均输注速率；2）自主睁眼及定向力恢复（姓名、日期和地点）的时间；3）进入麻醉后护理单元后24小时内使用的芬太尼总量。Ⅰ组、Ⅱ组、Ⅲ组和Ⅳ组的丙泊酚平均输注速率分别为10.1±2.5（均值±标准差）、7.5±1.2、5.7±1.1和4.9±1.2 mg·kg⁻¹·h⁻¹。接受芬太尼输注的组丙泊酚输注速率显著低于接受生理盐水输注的组（P<0.01）。在三个芬太尼输注组中，Ⅱ组（P<0.01）高于Ⅲ组和Ⅳ组。自主睁眼及定向力恢复时间与血浆芬太尼浓度直接相关。Ⅲ组和Ⅳ组的血浆芬太尼水平相同。术后24小时内静脉自控镇痛芬太尼总量在血浆芬太尼浓度顺序颠倒时显著增加，Ⅰ组、Ⅱ组、Ⅲ组和Ⅳ组分别为913.1±58.4、553.4±129、222.7±73.4和135.1±69.5 μg。这些结果表明，添加芬太尼输注具有封顶效应，可根据血浆芬太尼浓度降低术中丙泊酚需求量。封顶效应在意识恢复方面得到体现，但在术后镇痛的芬太尼需求方面未得到体现。
添加强效阿片类药物芬太尼可按血浆芬太尼浓度顺序降低静脉麻醉药丙泊酚的术中需求量。芬太尼的封顶效应在丙泊酚需求量降低和意识恢复方面得到体现，但在术后镇痛的芬太尼需求方面未得到体现。
