Cafiero T, Burrelli R, Latina P, Mastronardi P
Department of General and Specialistic Surgical Sciences, A Cardarelli Hospital, Naples, Italy.
Minerva Anestesiol. 2004 Jan-Feb;70(1-2):45-52.
Transition from the end of remifentanil infusion and postoperative analgesia must be planned carefully owing to remifentanil's (R) rapid offset. Intraoperative morphine has been used for the transition to postoperative analgesia following remifentanil-based anesthesia. Sufentanil (S) is a very potent opioid with high micro-receptor affinity, a much wider therapeutic index and a lower fractional receptor occupancy. These pharmacological and dynamics features make sufentanil an interesting alternative to morphine for immediate postoperative analgesia.
perspective, randomized, single blinded and comparative study. Institution: neurosurgical operating theatre at University.
96 patients, aging from 25 to 67 years, ASA class I-III, undergoing neurosurgical operations, were studied.
the anesthetic management was: premedication: atropine 0.01 microg kg(-1) + remifentanil 0.20 microg kg(-1) min(-1); induction: propofol 2.0 microg kg(-1) + cisatracurium 0.15 microg kg(-1); maintenance: sevoflurane 0.8% + remifentanil (titrated infusion) cisatracurium. All patients received ketorolac 30 mg i.v. 1 hour before the end of surgery and ketorolac (60-90 mg) + tramadol (200-300 mg) by elastomeric pump; patients were divided into 2 groups: group T receiving tramadol 100 mg and group S receiving a bolus dose of sufentanil 0.10 microg kg(-1), 30 and 15 minutes before the end of surgery respectively. Recovery time, postoperative analgesia evaluated by VAS, cardiocirculatory parameters and side effects like nausea, vomiting, shivering, muscle rigidity, sedation and respiratory depression were recorded.
VAS was significantly lower in Group S. Recovery time was shorter in Group T than in Group S (8.8 +/- 3.6 vs 11.6 +/- 4.6 min), no statistically significant differences between groups as regards nausea, vomiting and shivering. Short-lasting respiratory depression was detected in 3 cases in Group S.
At the emergence much better control of the transition phase in patients treated with sufentanil: smooth recovery with better tolerability of the endotracheal tube; efficacious analgesia along with cardiocirculatory stability.
由于瑞芬太尼作用迅速消除，必须谨慎规划瑞芬太尼输注结束与术后镇痛之间的过渡。术中使用吗啡已用于基于瑞芬太尼麻醉后的术后镇痛过渡。舒芬太尼是一种强效阿片类药物，具有高微观受体亲和力、更宽的治疗指数和更低的受体占有率。这些药理学和动力学特征使舒芬太尼成为术后即刻镇痛替代吗啡的一个有吸引力的选择。
前瞻性、随机、单盲和对照研究。机构：大学神经外科手术室。
研究了96例年龄在25至67岁、ASA分级为I - III级、接受神经外科手术的患者。
麻醉管理如下：术前用药：阿托品0.01μg/kg + 瑞芬太尼0.20μg·kg⁻¹·min⁻¹；诱导：丙泊酚2.0μg/kg + 顺式阿曲库铵0.15μg/kg；维持：七氟醚0.8% + 瑞芬太尼（滴定输注）+ 顺式阿曲库铵。所有患者在手术结束前1小时静脉注射酮咯酸30mg，并通过弹性泵给予酮咯酸（60 - 90mg）+ 曲马多（200 - 300mg）；患者分为2组：T组接受曲马多100mg，S组分别在手术结束前30分钟和15分钟接受舒芬太尼推注剂量0.10μg/kg。记录恢复时间、通过视觉模拟评分法（VAS）评估的术后镇痛、心血管循环参数以及恶心、呕吐、寒战、肌肉强直、镇静和呼吸抑制等副作用。
S组的VAS显著更低。T组的恢复时间比S组短（8.8 ± 3.6 vs 11.6 ± 4.6分钟），两组在恶心、呕吐和寒战方面无统计学显著差异。S组有3例出现短暂性呼吸抑制。
在苏醒期，接受舒芬太尼治疗的患者过渡阶段控制得更好：恢复平稳，对气管导管耐受性更好；镇痛有效且心血管循环稳定。
