Le Floch R, Naux E, Pilorget A, Arnould J-F
Pôle Anesthésie-Réanimations, Centre Hospitalier Universitaire, Nantes, France.
Ann Burns Fire Disasters. 2006 Sep 30;19(3):136-9.
We report our experience in using remifentanil as sole agent for the analgesia of spontaneously breathing non-intubated burn patients during dressing changes. Sixty procedures were collected and analysed. Remifentanil was used during monitoring of vital functions, with oxygen inhalation throughout the procedure, at the bedside in the intensive care unit ward. Infusion speed was varied by the nurse in charge, depending on pain, analgesia, and adverse effects. The dosage of continuous infusion ranged from 0.125 to 1 mg.kg-1.mn-1 (average, 0.42). All patients received intravenously morphine 30 min before the end of the procedure (average, 10 mg). The main side effects were hypoxia and drowsiness, always quickly reversed when the doses were reduced. All patients had low levels of pain during and after the procedure, and were satisfied with the analgesia protocol. We conclude that remifentanil is another possible manner of analgesia in the dressing of burn patients, but that it must be used in an "anaesthesiological" environment.
我们报告了在重症监护病房床边，将瑞芬太尼作为自主呼吸未插管烧伤患者换药时的唯一镇痛药物的经验。收集并分析了60例换药过程。在重症监护病房病房床边进行换药时，在监测生命体征的同时使用瑞芬太尼，并在整个过程中进行吸氧。负责的护士根据疼痛、镇痛效果和不良反应来改变输注速度。持续输注剂量范围为0.125至1mg·kg-1·min-1（平均0.42）。所有患者在操作结束前30分钟静脉注射吗啡（平均10mg）。主要副作用是缺氧和嗜睡，当减少剂量时总是能迅速逆转。所有患者在操作期间及操作后疼痛程度较低，并且对镇痛方案满意。我们得出结论，瑞芬太尼是烧伤患者换药时另一种可行的镇痛方式，但必须在“麻醉学”环境中使用。
