瑞芬太尼输注用于幼儿腭裂手术

Remifentanil infusion for cleft palate surgery in young infants.

作者信息

Roulleau P, Gall O, Desjeux L, Dagher C, Murat I

机构信息

Service d'Anesthésie-Réanimation, Centre Hospitalier Universitaire Armand Trousseau, Asssistance Publique des Hôpitaux de Paris, Paris, France.

出版信息

Paediatr Anaesth. 2003 Oct;13(8):701-7. doi: 10.1046/j.1460-9592.2003.01102.x.

DOI:10.1046/j.1460-9592.2003.01102.x

PMID:14535909

Abstract

BACKGROUND

The residual depressant effect of opioid is a major concern in infants scheduled for cleft palate repair. Remifentanil is associated with a fast and predictable recovery, independent of age.

METHODS

About 40 infants in the 2-12 month age range were prospectively enrolled in this open study, to receive either remifentanil (infusion starting at 0.25 microg x kg(-1) x min(-1)) or sufentanil as part of a balanced anaesthesia regimen. Isoflurane was maintained at an endtidal concentration of 1.2% in oxygen and nitrous oxide and the opioid dosing was titrated to autonomic responses. Postoperative pain relief was provided by morphine infusion. Morphine administration started intraoperatively in the remifentanil group.

RESULTS

Consistent haemodynamic stability was achieved throughout surgery in both groups. Infants of the remifentanil group required, on average, lower concentrations of isoflurane than children of the sufentanil group (1.2 +/- 0.2% vs 1.7 +/- 0.3%, P < 0.001). The median time from last suture to tracheal extubation was 12.5 min (5-25 min) in the remifentanil group and 15.0 min (10-30 min) in the sufentanil group. There was no evidence of hyperalgesia or enhanced morphine consumption in the remifentanil group compared with the sufentanil group. Postoperative pain scores were even lower in the remifentanil group, compared with the sufentanil group, soon after arrival in the postanaesthesia care unit.

CONCLUSIONS

Remifentanil-based anaesthesia appeared well suited for primary cleft palate repair in young infants.

摘要

背景

阿片类药物的残余抑制作用是计划进行腭裂修复手术的婴儿的主要关注点。瑞芬太尼与快速且可预测的恢复相关，与年龄无关。

方法

约40名年龄在2至12个月的婴儿前瞻性纳入本开放性研究，接受瑞芬太尼（输注起始剂量为0.25微克·千克⁻¹·分钟⁻¹）或舒芬太尼作为平衡麻醉方案的一部分。异氟烷在氧气和氧化亚氮中维持呼气末浓度为1.2%，阿片类药物剂量根据自主反应进行滴定。术后通过吗啡输注缓解疼痛。吗啡输注在瑞芬太尼组术中开始。

结果

两组在整个手术过程中均实现了持续的血流动力学稳定。瑞芬太尼组婴儿平均所需的异氟烷浓度低于舒芬太尼组儿童（1.2±0.2%对1.7±0.3%，P<0.001）。瑞芬太尼组从最后一针缝合到气管拔管的中位时间为12.5分钟（5至25分钟），舒芬太尼组为15.0分钟（10至30分钟）。与舒芬太尼组相比，瑞芬太尼组没有证据表明存在痛觉过敏或吗啡消耗量增加。与舒芬太尼组相比，瑞芬太尼组在进入麻醉后护理单元后不久术后疼痛评分更低。