添加两种靶控浓度（1 - 3纳克/毫升）瑞芬太尼对地氟烷肺泡最小有效浓度（MAC BAR）的影响。

The effect of adding two target-controlled concentrations (1-3 ng mL -1 ) of remifentanil on MAC BAR of desflurane.

作者信息

Albertin A, Dedola E, Bergonzi P C, Lombardo F, Fusco T, Torri G

机构信息

Department of Anesthesiology, IRCCS H. San Raffaele, Vita-Salute University of Milano, Milan, Italy.

出版信息

Eur J Anaesthesiol. 2006 Jun;23(6):510-6. doi: 10.1017/S0265021506000305.

DOI:10.1017/S0265021506000305

PMID:16672093

Abstract

BACKGROUND AND OBJECTIVES

The aim of this prospective, randomized, double-blind study was to determine the effects of adding two different target-controlled concentrations of remifentanil (1 and 3 ng mL(-1)) on the desflurane requirement for blunting sympathetic responses after surgical incision (minimum anaesthetic concentration (MAC(BAR)).

METHODS

67 patients, aged 20-50 yr, ASA I, undergoing general anaesthesia for elective abdominal surgery were enrolled and randomly allocated to receive no remifentanil infusion (n = 21) or a target-controlled effect-site concentration of 1 ng mL(-1) (n = 24) or 3 ng mL(-1) remifentanil (n = 22). All patients were anaesthetized with propofol, cisatracurium and desflurane with a mixture of 60% nitrous oxide in oxygen. Sympathetic responses to surgical incision were determined after a 20-min period of stable end-tidal desflurane and target-controlled remifentanil concentrations. Predetermined end-tidal desflurane concentrations and the MAC(BAR) for each group were determined using an up-and-down sequential-allocation technique.

RESULTS

The MAC(BAR) of desflurane was higher in the group receiving no remifentanil (6.25% [95% confidence interval: 5.9-6.5%]) as compared with patients of the groups receiving 1 ng mL(-1) (2.7% [2.6-2.8%]; P < 0.001) and 3 ng mL(-1) remifentanil (2% [1.9-2.2%]; P < 0.01). When considering a MAC value in this age population and the contribution of 60% nitrous oxide (0.55 MAC), the combined MAC(BAR) values, expressed as multiples of the MAC, were 1.9, 0.8 and 0.6 MAC, in the three groups, respectively.

CONCLUSION

A target-controlled concentration of 1 ng mL(-1) remifentanil results in a 57% decrease in the MAC(BAR) of desflurane combined with 60% nitrous oxide. Increasing the target concentration of remifentanil to 3 ng mL(-1) produces a further 26% decrease in the MAC(BAR) values of desflurane.

摘要

背景与目的

本前瞻性、随机、双盲研究旨在确定添加两种不同目标控制浓度的瑞芬太尼（1和3 ng/mL）对手术切口后抑制交感神经反应所需地氟烷浓度（最低肺泡有效浓度[MAC(BAR)]）的影响。

方法

纳入67例年龄在20至50岁、ASA I级、接受择期腹部手术全身麻醉的患者，随机分配接受不输注瑞芬太尼（n = 21）或目标控制效应室浓度为1 ng/mL（n = 24）或3 ng/mL瑞芬太尼（n = 22）。所有患者均采用丙泊酚、顺式阿曲库铵和地氟烷进行麻醉，并吸入60%氧化亚氮和氧气的混合气体。在呼气末地氟烷和目标控制瑞芬太尼浓度稳定20分钟后，测定对手术切口的交感神经反应。使用序贯分配技术确定每组预定的呼气末地氟烷浓度和MAC(BAR)。

结果

与接受1 ng/mL（2.7% [2.6 - 2.8%]；P < 0.001）和3 ng/mL瑞芬太尼（2% [1.9 - 2.2%]；P < 0.01）的患者相比，未接受瑞芬太尼的组中地氟烷的MAC(BAR)更高（6.25% [95%置信区间：5.9 - 6.5%]）。考虑到该年龄人群的MAC值以及60%氧化亚氮的贡献（0.55 MAC），三组中以MAC倍数表示的联合MAC(BAR)值分别为1.9、0.8和0.6 MAC。