Nakagaki Toshiaki, Kakinohana Manabu, Sugahara Kazuhiro
Department of Anesthesia, Self Defense Force Naha Hospital, Naha.
Masui. 2009 Jun;58(6):713-8.
We examined the hemodynamic responses to tracheal intubation during anesthetic induction by inhalational sevoflurane with continuous administration of remifentanil.
This study enrolled 30 ASA physical status 1-2 patients, aged 20-65 undergoing elective surgical procedure. Anesthesia was induced with 5% sevoflurane in all patients, and then adjusted to maintain BIS values ranging from 40 to 60. Remifentanil at the rate of 0.5 microg x kg(-1) x min(-1) was administrated continuously, and tracheal intubation was performed by each anesthesiologist, at various times after administration of remifentanil. We recorded blood pressure (BP), heart rate (HR) and the duration between the initiation of an administration of remifentanil and a tracheal intubation (DRI). Sympathetic response to tracheal intubation was defined as more than 20% increase in either BP or HR at the intubation compared with that at preintubation. We analyzed the P50, representing the duration of remifentanil infusion with 50% probability of blocking sympathetic response to tracheal intubation.
DRI for individual patients varied from 77 sec up to 660 sec. According to the present data, P50 was calculated as 210 +/- 16.4 sec (mean +/- SD).
During sevoflurane anesthesia, remifentanil infusion at 0.5 microg x kg(-1) x min(-1) for more than 210 sec could provide the effective blocking of the sympathetic response to tracheal intubation with more than 50% probability.
我们研究了在吸入七氟醚麻醉诱导期间持续输注瑞芬太尼时气管插管的血流动力学反应。
本研究纳入了30例年龄在20至65岁之间、美国麻醉医师协会（ASA）身体状况为1 - 2级、接受择期手术的患者。所有患者均采用5%七氟醚诱导麻醉，然后调整以维持脑电双频指数（BIS）值在40至60之间。以0.5μg·kg⁻¹·min⁻¹的速率持续输注瑞芬太尼，由每位麻醉医师在输注瑞芬太尼后的不同时间进行气管插管。我们记录了血压（BP）、心率（HR）以及从开始输注瑞芬太尼到气管插管之间的持续时间（DRI）。气管插管时的交感反应定义为插管时血压或心率相比插管前增加超过20%。我们分析了P50，它代表输注瑞芬太尼持续时间达到有50%概率阻断气管插管交感反应的时长。
个体患者的DRI从77秒到660秒不等。根据当前数据，计算得出P50为210 ± 16.4秒（平均值 ± 标准差）。
在七氟醚麻醉期间，以0.5μg·kg⁻¹·min⁻¹的速率输注瑞芬太尼超过210秒，有超过50%的概率能有效阻断气管插管的交感反应。
