Wilhelm W, Biedler A, Huppert A, Kreuer S, Bücheler O, Ziegenfuss T, Larsen R
University of Saarland, Department of Anaesthesiology and Intensive Care Medicine, Homburg/Saar, Germany.
Eur J Anaesthesiol. 2002 May;19(5):350-6. doi: 10.1017/s026502150200056x.
This prospective, randomized, double-blinded study was designed to compare the effects of remifentanil or fentanyl on anaesthetic induction characteristics of propofol, thiopental or etomidate.
Seventy-two patients were enrolled in six groups of 12 individuals each. In three groups, fentanyl was given as a bolus dose of 1.5 microg kg(-1), whereas the others received a remifentanil infusion at 0.5 microg kg(-1) min(-1). Five minutes later, propofol, thiopental or etomidate were titrated to a state of unresponsiveness. Assessment included the amounts of drug necessary for induction, haemodynamics and the times to apnoea, loss of eyelash reflex, and the release of a water-filled syringe held in the patient's hand.
Induction times to loss of the eyelash reflex were significantly shorter in the remifentanil than in the fentanyl groups: with propofol 50.7 +/- 13.6s (mean +/- SD) versus 74.9 +/- 27.0s (P < 0.01), with thiopental 42.9 +/- 16.8s versus 77.2 +/- 27.8s (P < 0.01) and with etomidate 54.7 +/- 17.6s versus 72.3 +/- 24.0s (P < 0.05). The times to respiratory arrest or for the syringe to fall were significantly shorter with remifentanil than with fentanyl for propofol and for thiopental, but not for etomidate. In terms of dosages per kg body weight necessary to achieve unresponsiveness, less propofol (-29%, P < 0.05), thiopental (-25%, P < 0.05) or etomidate (-32%, P < 0.01) was necessary with remifentanil than with fentanyl. Haemodynamic responses to tracheal intubation were controlled more effectively with remifentanil. However, within the remifentanil groups, mean arterial pressure significantly decreased during induction: -26% with propofol, -181% with thiopental and -14% with etomidate (all P < 0.01).
During anaesthetic induction, a remifentanil infusion of 0.5 microg kg(-1) min(-1) over 5 min is a suitable alternative to a 1.5 microg kg(-1) bolus dose of fentanyl: induction times are shorter with reduced amounts of propofol, thiopental or etomidate.
本前瞻性、随机、双盲研究旨在比较瑞芬太尼或芬太尼对丙泊酚、硫喷妥钠或依托咪酯麻醉诱导特征的影响。
72例患者被分为6组，每组12人。3组给予1.5μg/kg（-1）的芬太尼推注剂量，其他组以0.5μg/kg（-1）min（-1）的速率输注瑞芬太尼。5分钟后，滴定丙泊酚、硫喷妥钠或依托咪酯至无反应状态。评估内容包括诱导所需药物量、血流动力学以及呼吸暂停时间、睫毛反射消失时间和患者手中握持的注水注射器松开时间。
瑞芬太尼组睫毛反射消失的诱导时间显著短于芬太尼组：丙泊酚组分别为50.7±13.6秒（均值±标准差）和74.9±27.0秒（P<0.01），硫喷妥钠组分别为42.9±16.8秒和77.2±27.8秒（P<0.01），依托咪酯组分别为54.7±17.6秒和72.3±24.0秒（P<0.05）。对于丙泊酚和硫喷妥钠，瑞芬太尼组呼吸停止或注射器掉落的时间显著短于芬太尼组，但依托咪酯组无此差异。就达到无反应状态所需的每千克体重剂量而言，瑞芬太尼所需的丙泊酚（-29%，P<0.05）、硫喷妥钠（-25%，P<0.05）或依托咪酯（-32%，P<0.01）均少于芬太尼。瑞芬太尼对气管插管的血流动力学反应控制更有效。然而，在瑞芬太尼组中，诱导期间平均动脉压显著下降：丙泊酚组下降26%，硫喷妥钠组下降181%，依托咪酯组下降14%（均P<0.01）。
在麻醉诱导期间，5分钟内以0.5μg/kg（-1）min（-1）的速率输注瑞芬太尼是1.5μg/kg（-1）芬太尼推注剂量的合适替代方案：诱导时间更短，且丙泊酚、硫喷妥钠或依托咪酯用量减少。
