Yang Quan-yong, Xue Fu-shan, Liao Xu, Liu He-ping, Luo Mao-ping, Xu Ya-chao, Liu Yi, Zhang Yan-ming
Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Chin Med J (Engl). 2009 Jan 5;122(1):44-50.
The authors found no study to compare the efficacy of bolus dose fentanyl and remifentanil blunting the cardiovascular intubation response in children, so they designed this randomized, double-blind clinical study to assess the effects of remifentanil 2 microg/kg and fentanyl 2 microg/kg by bolus injection on the cardiovascular intubation response in healthy children.
One hundred and two children, the American Society of Anesthesiologists (ASA) physical status 1-2 and scheduled for elective plastic surgery under general anesthesia, were randomly divided into one of two groups to receive the following treatments in a double blind manner: remifentanil 2 microg/kg (Group R) and fentanyl 2 microg/kg (Group F) when anesthesia was induced with propofol and vecuronium. The orotracheal intubation was performed using a direct laryngoscope. Blood pressure (BP) and heart rate (HR) were recorded before anesthesia induction (baseline values), immediately before intubation, at intubation and every minute for 5 minutes after intubation. The percent changes of systolic blood pressure (SBP) and HR relative to baseline values and the rate pressure product (RPP) at every observing point were calculated. The incidences of SBP and HR percent changes >30% of baseline values and RPP >22,000 during the observation were recorded.
There were no significant differences between groups in the demographic data, baseline values of BP and HR and the intubation time. As compared to baseline values, BP, HR and RPP at intubation and their maximum values during observation increased significantly in Group F, but they all decreased significantly in Group R. BP, HR and RPP at all observed points, and their maximum values during the observation, were significantly different between groups. There were also significant differences between groups in the percent change of SBP and HR relative to baseline values at all observed points and their maximum percent changes during the observation. The incidences of SBP and HR percent increased >30% of the baseline values and RPP >22,000 during the observation, were significantly higher in Group F than in Group R, but the incidences of SBP and HR percent decreased >30% of baseline values were significantly lower in Group F compared with Group R.
When used as part of routine anesthesia induction with propofol and vecuronium in children, fentanyl 2 microg/kg by bolus injection fails to effectively depress the cardiovascular intubation response. Remifentanil 2 microg/kg by bolus injection can completely abolish the cardiovascular intubation response, but also cause more adverse complications of temporary significant cardiovascular depression.
作者发现尚无研究比较单次剂量芬太尼和瑞芬太尼对儿童心血管插管反应的抑制效果，因此设计了这项随机、双盲临床研究，以评估单次注射2微克/千克瑞芬太尼和2微克/千克芬太尼对健康儿童心血管插管反应的影响。
102名美国麻醉医师协会（ASA）身体状况为1 - 2级、计划在全身麻醉下进行择期整形手术的儿童，被随机分为两组之一，以双盲方式接受以下治疗：在用丙泊酚和维库溴铵诱导麻醉时，瑞芬太尼2微克/千克（R组）和芬太尼2微克/千克（F组）。使用直接喉镜进行经口气管插管。记录麻醉诱导前（基线值）、插管前即刻、插管时以及插管后5分钟内每分钟的血压（BP）和心率（HR）。计算每个观察点收缩压（SBP）和HR相对于基线值的变化百分比以及率压积（RPP）。记录观察期间SBP和HR变化百分比>基线值30%以及RPP>22,000的发生率。
两组在人口统计学数据、BP和HR基线值以及插管时间方面无显著差异。与基线值相比，F组插管时的BP、HR和RPP及其观察期间的最大值显著升高，但R组均显著降低。各观察点的BP、HR和RPP及其观察期间的最大值在两组间有显著差异。所有观察点SBP和HR相对于基线值的变化百分比及其观察期间的最大变化百分比在两组间也有显著差异。观察期间SBP和HR变化百分比>基线值30%以及RPP>22,000的发生率，F组显著高于R组，但SBP和HR变化百分比降低>基线值30%的发生率F组显著低于R组。
当作为儿童丙泊酚和维库溴铵常规麻醉诱导的一部分使用时，单次注射2微克/千克芬太尼不能有效抑制心血管插管反应。单次注射2微克/千克瑞芬太尼可完全消除心血管插管反应，但也会导致更多短暂性显著心血管抑制的不良并发症。
