Ozturk Tulun, Erbuyun Koray, Keles Gonul Tezcan, Ozer Mert, Yuksel Hasan, Tok Demet
Department of Anaesthesiology and Reanimation, Celal Bayar University School of Medicine, Manisa, Turkey.
Eur J Anaesthesiol. 2009 Apr;26(4):338-42. doi: 10.1097/EJA.0b013e32831de50d.
The aim of this study was to compare the effects of sevoflurane vs. sevoflurane and remifentanil on cough and agitation during emergence and recovery after fiberoptic bronchoscopy.
Children between 2 and 6 years of age undergoing fiberoptic bronchoscopy were enrolled. All patients were premedicated with oral midazolam. Patients were randomly assigned to either group S (sevoflurane alone, n = 25) or group SR (sevoflurane with remifetanil, n = 25). Anaesthesia was induced and maintained with sevoflurane in all patients. Group SR received remifentanil at a bolus dose of 1 microg/kg over 2 min followed by a maintenance infusion of 0.15 microg/kg/min. In addition to routine anaesthesia documentation, agitation scores and cough scores were recorded every 5 min during emergence and recovery.
Duration of the procedure, anaesthesia and emergence phases was similar in both groups (P > 0.05). Time until recovery was significantly shorter in group SR than in group S (7.0 +/- 5.5 min and 13.0 +/- 3.5 min, respectively; P = 0.001). Cough scores were not significantly different between the two groups during emergence and recovery (Kruskal-Wallis ANOVA test, P > 0.05). However, the mean agitation score at 5 min in group SR was significantly higher than that in group S (Kruskal-Wallis ANOVA test, P < 0.01). One case of hypoxaemia from thoracic rigidity occurred in a patient in group SR.
The addition of remifentanil significantly shortened recovery time in children undergoing fiberoptic bronchoscopy under sevoflurane anaesthesia. In the recovery period, remifentanil did not decrease cough, and increased agitation.
本研究旨在比较七氟醚与七氟醚复合瑞芬太尼对纤维支气管镜检查苏醒期和恢复期咳嗽及躁动的影响。
纳入2至6岁接受纤维支气管镜检查的儿童。所有患者均口服咪达唑仑进行术前用药。患者随机分为S组（单纯七氟醚，n = 25）或SR组（七氟醚复合瑞芬太尼，n = 25）。所有患者均采用七氟醚诱导和维持麻醉。SR组在2分钟内静脉推注瑞芬太尼1μg/kg，随后以0.15μg/kg/min的速度持续输注。除常规麻醉记录外，在苏醒期和恢复期每隔5分钟记录躁动评分和咳嗽评分。
两组手术、麻醉及苏醒期的持续时间相似（P > 0.05）。SR组的苏醒时间明显短于S组（分别为7.0±5.5分钟和13.0±3.5分钟；P = 0.001）。两组在苏醒期和恢复期的咳嗽评分无显著差异（Kruskal-Wallis方差分析检验，P > 0.05）。然而，SR组在5分钟时的平均躁动评分明显高于S组（Kruskal-Wallis方差分析检验，P < 0.01）。SR组有1例患者因胸壁强直出现低氧血症。
在七氟醚麻醉下行纤维支气管镜检查的儿童中，添加瑞芬太尼可显著缩短苏醒时间。在恢复期，瑞芬太尼并未减少咳嗽，反而增加了躁动。
