Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Korean J Anesthesiol. 2012 Aug;63(2):108-12. doi: 10.4097/kjae.2012.63.2.108. Epub 2012 Aug 14.
The injection pain of propofol is a frequent and well-known adverse effect. This study was designed to determine the optimal effect-site concentration of remifentanil for minimizing injection pain during induction with propofol.
A total intravenous anesthetic technique was used for patients undergoing general anesthesia and remifentanil was pretreated to reach a certain target concentration before propofol injection. Using Dixon's up-and-down method, the degree of pain described by the patient was used to adjust the target concentration of remifentanil for the next patient. Ten success-failure curves (crossovers) were sought to find the effect-site concentration (EC) of remifentanil for minimizing injection pain of propofol.
The EC of remifentanil in 50% and 95% of adult female population (EC(50) and EC(95)) for minimizing injection pain of propofol were 3.09 ng/ml (95% confidence limits [CI] 2.92-3.30 ng/ml) and 3.78 ng/ml (95% CI 3.45-3.95 ng/ml), respectively. Clinically significant hemodynamic compromise or respiratory complications were not found during remifentanil infusion.
Maintaining 3.78 ng/ml EC of remifentanil during induction with propofol attenuate propofol injection pain without serious adverse events in female patients undergoing general anesthesia and this method may provide the patient's comfort without preparing other drugs for pain relief.
丙泊酚注射痛是一种常见且广为人知的不良反应。本研究旨在确定瑞芬太尼的最佳效应室浓度，以最大限度地减少丙泊酚诱导时的注射痛。
采用全静脉麻醉技术，在给予丙泊酚前预先给予瑞芬太尼以达到一定的目标浓度。采用 Dixon 的上下法，根据患者描述的疼痛程度调整下一个患者的瑞芬太尼目标浓度。寻找 10 条成功-失败曲线（交叉），以找到最小化丙泊酚注射痛的瑞芬太尼效应室浓度（EC）。
在女性成年人群体中，50%和 95%能够最小化丙泊酚注射痛的瑞芬太尼 EC（EC（50）和 EC（95））分别为 3.09ng/ml（95%置信区间[CI] 2.92-3.30ng/ml）和 3.78ng/ml（95% CI 3.45-3.95ng/ml）。在瑞芬太尼输注期间未发现有临床显著的血流动力学障碍或呼吸并发症。
在女性全麻患者中，维持丙泊酚诱导时 3.78ng/ml 的瑞芬太尼 EC 可减轻丙泊酚注射痛，且无严重不良事件，这种方法可以为患者提供舒适感，而无需准备其他用于缓解疼痛的药物。
