Sato Kiyotaka, Iwasaki Masaki, Kato Masato
Department of Neuroanesthesia, Kohnan Hospital, Sendai 982-8523.
Masui. 2010 Feb;59(2):188-92.
In surgeries for epilepsy, electrocorticography (ECoG) enables tailored resection of the epileptogenic brain and pharmacological stimulation should be employed in surgeries under general anesthesia. To identify the efficacy of continuous remifentanil in surgeries for epilepsy, ECoG findings with remifentanil and those with sevoflurane were compared.
Sixteen patients with intractable epilepsy were included with institutional ethics committee approval and informed consent. General anesthesia was induced and maintained with sevoflurane, remifentanil and rocuronium. After dural opening, ECoG recordings were obtained before stimulation, with sevoflurane-stimulation (ET-sevoflurane 2.5%) and with remifentanil-stimulation (0.7 microg x kg(-1) x min(-1) for 2 min followed by 0.35 microg x kg(-1) x min(-1)).
In 11 of the 16 cases, activation was confirmed with remifentanil and numbers of spikes with remifentanil- and sevoflurane-stimulation were larger than those before stimulation.
There have been some reports on bolus remifentanil on ECoG but not on its continuous infusion. This is the first report of the effect of remifentanil on ECoG as compared to sevoflurane. In this study, continuous infusion of remifentanil showed a stimulating effect on ECoG with the same potency as sevoflurane. Remifentanil may be used as an alternative to sevoflurane.
在癫痫手术中，皮质脑电图（ECoG）有助于对致痫脑区进行精准切除，且在全身麻醉手术中应采用药物刺激。为确定瑞芬太尼持续输注在癫痫手术中的效果，比较了使用瑞芬太尼和七氟醚时的ECoG结果。
16例难治性癫痫患者经机构伦理委员会批准并获得知情同意后纳入研究。采用七氟醚、瑞芬太尼和罗库溴铵诱导并维持全身麻醉。硬脑膜切开后，在刺激前、七氟醚刺激（呼气末七氟醚浓度2.5%）和瑞芬太尼刺激（0.7μg·kg⁻¹·min⁻¹持续2分钟，随后0.35μg·kg⁻¹·min⁻¹）时记录ECoG。
16例患者中有11例在使用瑞芬太尼时出现激活，且瑞芬太尼刺激和七氟醚刺激时的棘波数量均多于刺激前。
已有关于单次推注瑞芬太尼对ECoG影响的报道，但尚无关于其持续输注影响的报道。这是第一篇比较瑞芬太尼与七氟醚对ECoG影响的报告。在本研究中，瑞芬太尼持续输注对ECoG显示出与七氟醚相同强度的刺激作用。瑞芬太尼可作为七氟醚的替代药物。
