瑞芬太尼对咪达唑仑诱导麻醉及随后气管插管对心血管和脑电双频指数反应的影响。
Effect of remifentanil on cardiovascular and bispectral index responses following the induction of anesthesia with midazolam and subsequent tracheal intubation.
机构信息
Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abeno-ku, Osaka, 545-8586, Japan.
出版信息
J Anesth. 2010 Apr;24(2):161-7. doi: 10.1007/s00540-010-0895-4. Epub 2010 Feb 26.
PURPOSE
We examined the hypothesis that remifentanil decreases the bispectral index (BIS) as well as blunts cardiovascular responses to tracheal intubation during anesthesia with midazolam.
METHODS
Sixty patients were randomly allocated to three groups according to the dose of remifentanil-0.1 (S), 0.2 (M), or 0.5 (L) microg kg(-1) min(-1), respectively. Infusion of remifentanil was started 5 min before the induction of general anesthesia with midazolam 0.2 mg/kg in all groups. Following the administration of vecuronium 0.1 mg/kg, the trachea was intubated 5 min after induction, and the infusion rate of remifentanil was then reduced to 0.05 microg kg(-1) min(-1) in all groups. Mean arterial blood pressure (MAP), heart rate (HR), BIS, and 95% spectral edge frequency (SEF95) were measured until 10 min after tracheal intubation.
RESULTS
Infusion of remifentanil alone before the induction of anesthesia did not affect the hemodynamic or electroencephalographic parameters. MAP was significantly decreased after induction in all groups of patients (P < 0.01), with no differences among the three groups, while it was significantly increased after tracheal intubation in the patients of groups S and M, but not in those of group L. The HR did not change after induction in any of the groups, but it was also significantly increased after tracheal intubation of group S and M patients, although not in those of group L. The BIS decreased after induction, and both the BIS and SEF95 were significantly lower in group L patients than in those of group S (P < 0.01). All patients were unconscious after induction, and none complained of intraoperative awareness.
CONCLUSION
In our patient cohort, remifentanil 0.5 microg kg(-1) min(-1) effectively decreased the BIS after the induction of general anesthesia with midazolam 0.2 mg/kg and suppressed the increase of MAP and HR in response to subsequent laryngoscopy and tracheal intubation.
目的
我们检验了假设，即在咪达唑仑麻醉中，瑞芬太尼降低了脑电双频指数（BIS）并使心血管对气管插管的反应迟钝。
方法
根据瑞芬太尼剂量（S 组 0.1μg·kg-1·min-1、M 组 0.2μg·kg-1·min-1、L 组 0.5μg·kg-1·min-1），将 60 名患者随机分为三组。所有患者均在给予咪达唑仑 0.2mg/kg 诱导全麻前 5 分钟开始输注瑞芬太尼。给予维库溴铵 0.1mg/kg 后，诱导后 5 分钟行气管插管，然后所有患者瑞芬太尼输注率降至 0.05μg·kg-1·min-1。测量气管插管前 10 分钟内平均动脉血压（MAP）、心率（HR）、BIS 和 95%频谱边缘频率（SEF95）。
结果
麻醉诱导前单独输注瑞芬太尼不影响血流动力学或脑电图参数。所有患者诱导后 MAP 明显下降（P<0.01），三组间无差异，而气管插管后 S 组和 M 组患者 MAP 明显升高，但 L 组患者无变化。诱导后各组 HR 无变化，但 S 组和 M 组患者气管插管后 HR 明显升高，而 L 组患者无变化。BIS 在诱导后下降，L 组患者的 BIS 和 SEF95 均明显低于 S 组（P<0.01）。所有患者诱导后均无意识，术中均无知晓。
结论
在我们的患者人群中，瑞芬太尼 0.5μg·kg-1·min-1 可有效降低咪达唑仑 0.2mg/kg 诱导全麻后的 BIS，并抑制随后喉镜检查和气管插管引起的 MAP 和 HR 增加。
Zotero 插件