Department of Anesthesiology and Pain Medicine, Inha University, College of Medicine, Incheon, 400-103, South Korea.
J Clin Anesth. 2011 Aug;23(5):379-83. doi: 10.1016/j.jclinane.2010.12.012. Epub 2011 Jul 8.
To determine the most suitable effect-site concentration of remifentanil during lightwand intubation when administered with a target-controlled infusion (TCI) of propofol at 4.0 μg/mL without neuromuscular blockade.
Prospective study using a modified Dixon's up-and-down method.
Operating room of an academic hospital.
28 ASA physical status 1 and 2 patients, aged 18-65 years, scheduled for minor elective surgery.
Anesthesia was induced by TCI propofol effect-site concentration to 4.0 μg/mL, and the dose of remifentanil given to each patient was determined by the response of the previously tested patient using 0.2 ng/mL as a step size. The first patient was tested at a target effect-site concentration of 4.0 ng/mL of remifentanil. If intubation was successful, the remifentanil dose was decreased by 0.2 ng/mL; if it failed, the remifentanil dose was increased by 0.2 ng/mL. Successful intubation was defined as excellent or good intubating conditions.
The remifentanil effect-site concentration was measured. The optimal effect-site concentration of remifentanil for lightwand tracheal intubation during propofol induction using 2% propofol target effect-site concentration to 4 μg/mL was 2.16 ± 0.19 ng/mL. From probit analysis, the effect-site concentration of remifentanil required for successful lightwand intubation in 50% (EC50) and 95% (EC95) of adults was 2.11 ng/mL (95% CI 1.16-2.37 ng/mL) and 2.44 ng/mL (95% CI 2.20-3.79 ng/mL), respectively.
A remifentanil effect-site concentration of 2.16 ± 0.19 ng/mL given before a propofol effect-site concentration of 4 μg/mL allowed lightwand intubation without muscle relaxant.
在无神经肌肉阻滞的情况下，使用丙泊酚靶控输注（TCI）4.0μg/mL 时，确定雷米芬太尼最适合的效应部位浓度用于光棒插管。
前瞻性研究，采用改良的 Dixon 上下法。
学术医院手术室。
28 名 ASA 身体状况 1 和 2 级患者，年龄 18-65 岁，择期行小手术。
麻醉诱导采用丙泊酚效应部位浓度 TCI 至 4.0μg/mL，根据之前接受测试的患者的反应确定给予每位患者的雷米芬太尼剂量，步长为 0.2ng/mL。第一例患者的目标效应部位浓度为 4.0ng/mL 的雷米芬太尼。如果插管成功，则减少雷米芬太尼剂量 0.2ng/mL；如果失败，则增加雷米芬太尼剂量 0.2ng/mL。成功插管定义为插管条件极好或良好。
测量雷米芬太尼的效应部位浓度。在丙泊酚诱导时使用 2%丙泊酚靶效应部位浓度至 4μg/mL，雷米芬太尼用于光棒气管插管的最佳效应部位浓度为 2.16±0.19ng/mL。从概率分析来看，50%（EC50）和 95%（EC95）成人成功进行光棒插管所需的雷米芬太尼效应部位浓度分别为 2.11ng/mL（95%CI 1.16-2.37ng/mL）和 2.44ng/mL（95%CI 2.20-3.79ng/mL）。
在丙泊酚效应部位浓度为 4μg/mL 之前给予 2.16±0.19ng/mL 的雷米芬太尼，可以在没有肌肉松弛剂的情况下进行光棒插管。
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