Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Anaesthesia. 2009 Dec;64(12):1307-11. doi: 10.1111/j.1365-2044.2009.06127.x. Epub 2009 Oct 13.
This study investigated the effect of intrathecal fentanyl on the dose of propofol during sedation guided by Cerebral State Index monitoring. Seventy patients were randomly assigned to receive either fentanyl 25 microg (n = 35) or normal saline (n = 35) with hyperbaric bupivacaine 12.5 mg for spinal anaesthesia. Propofol was infused to maintain a Cerebral State Index value of 65-75 for 30 min. The propofol infusion time and dose required to reach a Cerebral State Index value of 75 were recorded together with the time required to reach a Cerebral State Index value higher than 90 after cessation of sedation. The onset time for sedation was faster and the recovery time was slower in the fentanyl group compared to those in the saline group (p = 0.018 and 0.027, respectively). The propofol doses required for onset and maintenance of sedation were significantly lower in the fentanyl group compared to those in the control group (p = 0.018 and < 0.001, respectively). In conclusion, adding intrathecal fentanyl 25 microg during spinal anaesthesia significantly reduced the dose of propofol required for sedation and prolonged the subsequent recovery time.
本研究旨在探讨鞘内注射芬太尼对脑电双频指数指导下镇静时丙泊酚剂量的影响。将 70 例患者随机分为鞘内注射芬太尼 25μg（n=35）或生理盐水（n=35），同时给予重比重布比卡因 12.5mg 行蛛网膜下腔阻滞。丙泊酚输注以维持脑电双频指数值在 65-75 之间 30 分钟。记录达到脑电双频指数值 75 所需的丙泊酚输注时间和剂量，以及镇静停止后达到脑电双频指数值高于 90 所需的时间。与生理盐水组相比，芬太尼组的镇静起效时间更快，恢复时间更慢（p=0.018 和 0.027）。与对照组相比，芬太尼组用于诱导和维持镇静的丙泊酚剂量明显降低（p=0.018 和 <0.001）。结论：蛛网膜下腔阻滞时鞘内注射芬太尼 25μg 可显著降低镇静所需的丙泊酚剂量，并延长随后的恢复时间。
