Lentschener C, Ghimouz A, Bonnichon P, Pépion C, Gomola A, Ozier Y
Department of Anesthesia and Intensive Care, Hôpital Cochin, Université René Descartes, Paris.
Acta Anaesthesiol Scand. 2003 Jan;47(1):84-9. doi: 10.1034/j.1399-6576.2003.470115.x.
Two opioid regimens, computer-simulated to provide optimal general anesthesia in combination with propofol, were compared using clinical criteria.
Fifty patients undergoing thyroid surgery were blindly, prospectively and randomly allocated to receive either (a) i.v. remifentanil (1.5 micro g kg-1, followed by 0.2 micro g kg-1 min-1) or (b) i.v. sufentanil (0.2 micro g kg-1 followed by 0.2 micro g kg-1 h-1). Remifentanil infusion was stopped at the last skin suture. Sufentanil infusion was stopped 30 min before the end of surgery. Intravenous propofol was titrated to keep BIS at 50+/-5. Remifentanil and sufentanil groups were compared with regards to (a) propofol delivery, (b) hemodynamic and recovery variables, and (c) effect-site propofol levels during a steady-state period for effect-site remifentanil and sufentanil levels. P<0.05 was significant.
Groups were similar in demographic data; types and durations of surgery; total propofol consumption; and response, extubation and emergence times. During the steady-state period for the opioid delivery, the remifentanil and sufentanil effect-site levels were 5.3 ng ml-1 and 0.18 ng ml-1, respectively (potency ratio=30). In both opioid groups, in accordance with previous computer-simulations, the effect-site propofol concentrations remained (a) within a narrow range unaffected by surgical stimuli, (b) significantly smaller in the remifentanil group than in the sufentanil group, but (c) smaller than expected from previous computer-simulations. More patients required ephedrine following induction of anesthesia in the remifentanil compared with the sufentanil group.
The present clinical trial conducted in thyroid surgery is consistent with previous computer-simulated opioid-propofol combinations with respect to intraoperative and recovery variables. Effect-site propofol ranges were, however, lower than expected.
使用临床标准比较了两种经计算机模拟与丙泊酚联合使用以提供最佳全身麻醉的阿片类药物方案。
50例接受甲状腺手术的患者被前瞻性、随机且盲法分配，分别接受：(a)静脉注射瑞芬太尼（1.5μg/kg，随后0.2μg·kg⁻¹·min⁻¹）或(b)静脉注射舒芬太尼（0.2μg/kg，随后0.2μg·kg⁻¹·h⁻¹）。在缝完最后一针皮肤时停止输注瑞芬太尼。在手术结束前30分钟停止输注舒芬太尼。静脉注射丙泊酚进行滴定以使脑电双频指数（BIS）维持在50±5。比较瑞芬太尼组和舒芬太尼组在以下方面的情况：(a)丙泊酚用量；(b)血流动力学和恢复变量；以及(c)在效应室瑞芬太尼和舒芬太尼达到稳态水平期间的效应室丙泊酚水平。P<0.05为有显著性差异。
两组在人口统计学数据、手术类型和持续时间、丙泊酚总用量以及反应、拔管和苏醒时间方面相似。在阿片类药物输注的稳态期，瑞芬太尼和舒芬太尼的效应室水平分别为5.3ng/ml和0.18ng/ml（效价比=30）。在两个阿片类药物组中，与之前的计算机模拟结果一致，效应室丙泊酚浓度保持：(a)在不受手术刺激影响的窄范围内；(b)瑞芬太尼组显著低于舒芬太尼组；但(c)低于之前计算机模拟预期的值。与舒芬太尼组相比，瑞芬太尼组在麻醉诱导后更多患者需要麻黄碱。
本次在甲状腺手术中进行的临床试验在术中及恢复变量方面与之前计算机模拟的阿片类药物-丙泊酚联合使用情况一致。然而，效应室丙泊酚范围低于预期。
