Tarkkila P, Viitanen H, Mennander S, Annila P
ENT-Hospital, Department of Anaesthesia and Intensive Care, Helsinki University Central Hospital, Finland.
Acta Anaesthesiol Belg. 2003;54(3):217-22.
Few studies exist of using remifentanil and intravenous ketamine for anaesthetic induction in paediatric day case anaesthesia. Therefore, we studied 75 unpremedicated ASA I-II children (age 1-7 years) who were randomly assigned in a double-blind fashion to receive either remifentanil (1 microgram/kg), ketamine (0.7 mg/kg) or placebo before the anaesthetic induction. Anaesthesia was induced with propofol and maintained with O2-N2O-sevoflurane. Induction characteristics, recovery times and the need for postoperative analgesia were evaluated. The required induction dose of propofol was lower in the groups receiving remifentanil and ketamine compared with the group receiving placebo. After tracheal intubation heart rate and blood pressure were better attenuated with remifentanil than with ketamine or placebo. In the recovery room children in the placebo group required more doses of oxycodone than the other two groups but this did not reach statistical significance. There were no differences between the groups in achieving predetermined recovery end-points, attaining full points on the Steward score or in the well being at home. In conclusion, remifentanil provides haemodynamically more stable induction of anaesthesia compared with ketamine or placebo. Ketamine with its' longer duration of action does not prolong recovery but does not have a clear opioid-sparing effect either in the immediate postoperative period.
关于在小儿日间手术麻醉中使用瑞芬太尼和静脉注射氯胺酮进行麻醉诱导的研究很少。因此，我们研究了75名未使用术前药的ASA I-II级儿童（年龄1 - 7岁），他们被双盲随机分配，在麻醉诱导前接受瑞芬太尼（1微克/千克）、氯胺酮（0.7毫克/千克）或安慰剂。麻醉诱导采用丙泊酚，维持采用O2 - N2O - 七氟醚。评估了诱导特征、恢复时间和术后镇痛需求。与接受安慰剂的组相比，接受瑞芬太尼和氯胺酮的组所需的丙泊酚诱导剂量更低。气管插管后，瑞芬太尼对心率和血压的抑制作用比氯胺酮或安慰剂更好。在恢复室，安慰剂组的儿童比其他两组需要更多剂量的羟考酮，但这未达到统计学意义。在达到预定的恢复终点、Steward评分获得满分或在家中的舒适度方面，各组之间没有差异。总之，与氯胺酮或安慰剂相比，瑞芬太尼在血流动力学方面能更稳定地诱导麻醉。氯胺酮作用时间较长，虽不延长恢复时间，但在术后即刻也没有明显的节省阿片类药物的作用。
