Surgical Operation Department, Asahikawa Medical College Hospital, Asahikawa, Japan.
J Anesth. 2012 Oct;26(5):790-3. doi: 10.1007/s00540-012-1395-5. Epub 2012 May 3.
We evaluated whether the effect of remifentanil treatment differs between normal weight (NW) patients with real body weight-based remifentanil and mildly obese (Ob) patients with ideal body weight based-remifentanil during short-term anesthetic induction. We enrolled 20 patients aged between 20 and 64 years in each group (NW group: 18.5 kg/m(2) ≤ BMI < 25 kg/m(2); Ob group: BMI ≥ 25 kg/m(2)). Tracheal intubation (TI) was performed after administration of 0.5 μg/kg/min remifentanil for 5 min, including 2 min of antecedent administration, with propofol and rocuronium. Hemodynamic parameters (SBP, DBP, and HR) were measured. Percent changes in hemodynamics resulting from anesthetic induction and TI were calculated, and effect-site concentration (ESC) in each patient was calculated by performing pharmacokinetic simulation. All hemodynamic values in the Ob group after TI were significantly higher than those in the NW group. Percent increases in SBP and HR in the Ob group were significantly higher than the corresponding values in the NW group. ESC of remifentanil at the time of TI in the NW group was higher than that in the Ob group. Remifentanil treatment with anesthetic induction based on the Japanese package insert might have insufficient effects in obese patients.
我们评估了在短期麻醉诱导期间，接受基于实际体重的瑞芬太尼治疗的正常体重（NW）患者和接受基于理想体重的瑞芬太尼治疗的轻度肥胖（Ob）患者之间，瑞芬太尼治疗的效果是否存在差异。我们在每组中纳入了 20 名年龄在 20 岁至 64 岁之间的患者（NW 组：18.5kg/m(2)≤BMI＜25kg/m(2)；Ob 组：BMI≥25kg/m(2)）。在给予瑞芬太尼 0.5μg/kg/min 5 分钟后（包括 2 分钟的预给药），给予异丙酚和罗库溴铵，进行气管插管（TI）。测量血流动力学参数（SBP、DBP 和 HR）。计算麻醉诱导和 TI 引起的血流动力学百分比变化，并通过进行药代动力学模拟计算每位患者的效应部位浓度（ESC）。TI 后 Ob 组的所有血流动力学值均明显高于 NW 组。Ob 组的 SBP 和 HR 百分比增加均明显高于 NW 组。NW 组 TI 时的瑞芬太尼 ESC 高于 Ob 组。根据日本说明书进行麻醉诱导的瑞芬太尼治疗可能对肥胖患者效果不足。
