Castanelli Damian J, Splinter William M, Clavel Natalie A
Department of Anesthesia, Monash Medical Centre, Clayton, Victoria, Australia.
Can J Anaesth. 2005 Dec;52(10):1064-70. doi: 10.1007/BF03021606.
To establish the effect of increasing concentrations of remifentanil on sevoflurane requirements in children.
Fifty-eight healthy patients, ASA status I-II aged two to 12 yr, undergoing abdominal wall hernia or hydrocele repairs were serially assigned to one of four test groups to receive remifentanil 0.03 microg.kg(-1).min(-1), 0.06 microg.kg(-1).min(-1), 0.12 microg.kg(-1).min(-1), or 0.25 microg.kg(-1).min(-1) iv. Patients received a bolus of remifentanil 1 microg.kg(-1) iv before the infusion began. End-tidal sevoflurane concentration was adjusted according to a Dixon up-and-down approach. Ten minutes after starting the remifentanil infusion, the surgical incision was made. The patient was observed for one minute from the time of incision by a solitary blinded rater for either flexion or withdrawal of one or more extremities in response to skin incision.
The mean minimum alveolar concentration of sevoflurane was 2.39 +/- 0.58 with 0.03 microg.kg(-1).min(-1) remifentanil, 1.91 +/- 0.36 with 0.06 microg.kg(-1).min(-1) remifentanil, and 0.92 +/- 0.11 with 0.12 microg.kg(-1).min(-1) remifentanil. Remifentanil 0.25 microg.kg(-1).min(-1) lead to the sevoflurane being decreased to a level associated with spontaneous patient awakening. The effective dose (ED(50)) values of sevoflurane were 2.44 [95% confidence interval (CI) 2.16-2.72], 2.00 (95% CI 1.78-2.22), and 1.18 (95% CI 0.99-1.36) for remifentanil infusion rates of 0.03 microg.kg(-1).min(-1), 0.06 microg.kg(-1).min(-1), and 0.12 microg.kg(-1).min(-1) respectively.
The administration of remifentanil produced a dose-dependent decrease in the minimum alveolar concentration of sevoflurane necessary for inhibition of movement reaction in response to surgical incision. The use of remifentanil may allow for flexible analgesic control and rapid recovery in children anesthetized with sevoflurane.
确定瑞芬太尼浓度增加对儿童七氟醚需求量的影响。
58例年龄在2至12岁、ASA分级为I-II级的健康患儿，接受腹壁疝或鞘膜积液修补术，被依次分配到四个试验组之一，静脉输注瑞芬太尼，剂量分别为0.03μg·kg⁻¹·min⁻¹、0.06μg·kg⁻¹·min⁻¹、0.12μg·kg⁻¹·min⁻¹或0.25μg·kg⁻¹·min⁻¹。在输注开始前，患儿静脉注射负荷剂量瑞芬太尼1μg·kg⁻¹。根据Dixon上下法调整呼气末七氟醚浓度。瑞芬太尼输注开始10分钟后进行手术切口。由一名独立的盲法评估者在切口时观察患儿一分钟，观察其一个或多个肢体对皮肤切口的屈曲或回缩反应。
瑞芬太尼剂量为0.03μg·kg⁻¹·min⁻¹时，七氟醚的平均最低肺泡浓度为2.39±0.58；瑞芬太尼剂量为0.06μg·kg⁻¹·min⁻¹时，七氟醚的平均最低肺泡浓度为1.91±0.36；瑞芬太尼剂量为0.12μg·kg⁻¹·min⁻¹时，七氟醚的平均最低肺泡浓度为0.92±0.11。瑞芬太尼剂量为0.25μg·kg⁻¹·min⁻¹时，七氟醚浓度降至与患儿自主苏醒相关的水平。瑞芬太尼输注速率分别为0.03μg·kg⁻¹·min⁻¹、0.06μg·kg⁻¹·min⁻¹和0.12μg·kg⁻¹·min⁻¹时，七氟醚的有效剂量（ED₅₀）值分别为2.44[95%置信区间（CI）2.16 - 2.72]、2.00（95%CI 1.78 - 2.22）和1.18（95%CI 0.99 - 1.36）。
输注瑞芬太尼可使抑制手术切口所致运动反应所需的七氟醚最低肺泡浓度呈剂量依赖性降低。使用瑞芬太尼可实现对接受七氟醚麻醉儿童的灵活镇痛控制及快速苏醒。
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