Ryu J-H, Sohn I-S, Do S-H
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166 Kumi-Ro, Bundang-gu, Seongnam-si, Kyonggi-do 463-707, Republic of Korea.
Br J Anaesth. 2009 Oct;103(4):490-5. doi: 10.1093/bja/aep229. Epub 2009 Aug 17.
This prospective, randomized study was designed to compare remifentanil and magnesium sulphate during middle ear surgery in terms of postoperative pain and other complications.
Eighty patients undergoing middle ear surgery were enrolled in the study. Patients were randomized into two groups of 40 to receive remifentanil (Group R) or magnesium sulphate (Group M) infusion. Propofol 2 mg kg(-1) was administered to induce anaesthesia, which was maintained using sevoflurane. Group R received a continuous infusion of remifentanil titrated between 3 and 4 ng ml(-1) using target-controlled infusion, whereas Group M received an i.v. magnesium sulphate bolus of 50 mg kg(-1) followed by a 15 mg kg(-1) h(-1) continuous infusion to maintain a mean arterial pressure (MAP) between 60 and 70 mm Hg. Haemodynamic variables, surgical conditions, postoperative pain, and adverse effects, such as postoperative nausea and vomiting (PONV) and shivering, were recorded.
Controlled hypotension was well maintained in both groups. MAP and heart rate were higher in Group R than in Group M after operation. Surgical conditions were not different between the two groups. Postoperative pain scores were significantly lower in Group M than in Group R (P<0.05). Seventeen patients in Group R (43%) and seven patients in Group M (18%) developed PONV (P=0.01).
Both magnesium sulphate and remifentanil when combined with sevoflurane provided adequate controlled hypotension and proper surgical conditions for middle ear surgery. However, patients administered magnesium sulphate had a more favourable postoperative course with better analgesia and less shivering and PONV.
本前瞻性随机研究旨在比较瑞芬太尼和硫酸镁在中耳手术中的术后疼痛及其他并发症情况。
80例接受中耳手术的患者纳入本研究。患者被随机分为两组，每组40例，分别接受瑞芬太尼输注（R组）或硫酸镁输注（M组）。给予丙泊酚2mg·kg⁻¹诱导麻醉，并用七氟醚维持麻醉。R组采用靶控输注持续输注瑞芬太尼，靶浓度滴定在3至4ng·ml⁻¹之间，而M组静脉注射50mg·kg⁻¹硫酸镁推注，随后以15mg·kg⁻¹·h⁻¹持续输注以维持平均动脉压（MAP）在60至70mmHg之间。记录血流动力学变量、手术情况、术后疼痛及不良反应，如术后恶心呕吐（PONV）和寒战。
两组均良好维持了控制性低血压。术后R组的MAP和心率高于M组。两组手术情况无差异。M组术后疼痛评分显著低于R组（P<0.05）。R组17例患者（43%）发生PONV，M组7例患者（18%）发生PONV（P=0.01）。
硫酸镁和瑞芬太尼与七氟醚联合应用均为中耳手术提供了充分的控制性低血压和合适的手术条件。然而，接受硫酸镁治疗的患者术后过程更有利，镇痛效果更好，寒战和PONV更少。
