Wu Jing, Liu Lili, Yang Fan
Department of Anesthesiology, Hankou Hospital, Wuhan 430012, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2012 Sep;32(9):1316-8.
To explore the efficacy and safety of small-dose remifentanil for attenuating cardiovascular response to tracheal extubation after surgery with general anesthesia.
A total of 164 patients scheduled for upper abdominal operation were randomized into groups A (n=41), B (n=43), C (n=40) and D (n=40). In groups A, B, and C, the patients received continuous infusion of remifentanil at the doses of 0.05, 0.10 and 0.20 µg·kg(-1)·min(-1), respectively, while those in group D were not given any drug before tracheal extubation. The change of systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were recorded before induction of anesthesia (T1), at the time of extubation (T2), and at 1 min (T3), 3 min (T4), and 5 min (T5) after extubation. The recovery time and adverse effect of extubation were recorded.
In each group, SBP, DBP and HR at T2 and T3 were significantly higher than those at T1 (P<0.05). SBP, DBP and HR were significantly higher in groups A, B and C than in group D (P<0.05), and significantly higher in groups A and B than in group C. The time of spontaneous breath recovery and awaking showed no significant difference in the 4 groups (P>0.05). The rates of adverse effect (nausea and vomiting) in groups A and B were significantly lower than that in group C (P<0.05), but comparable between groups A and B (P>0.05).
Remifentanil at the optimal dose of 0.10 µg·kg(-1)·min(-1) can effectively prevent cardiovascular response to tracheal extubation and reduce the adverse effect associated with anesthesia without prolonging the recovery time.
探讨小剂量瑞芬太尼减轻全身麻醉术后气管拔管时心血管反应的有效性及安全性。
将164例择期行上腹部手术的患者随机分为A组（n = 41）、B组（n = 43）、C组（n = 40）和D组（n = 40）。A组、B组和C组患者分别持续输注剂量为0.05、0.10和0.20μg·kg⁻¹·min⁻¹的瑞芬太尼，而D组患者在气管拔管前未给予任何药物。记录麻醉诱导前（T1）、拔管时（T2）以及拔管后1分钟（T3）、3分钟（T4）和5分钟（T5）时收缩压（SBP）、舒张压（DBP）和心率（HR）的变化。记录拔管的恢复时间及不良反应。
每组患者T2和T3时的SBP、DBP和HR均显著高于T1时（P < 0.05）。A组、B组和C组的SBP、DBP和HR显著高于D组（P < 0.05），且A组和B组显著高于C组。4组患者自主呼吸恢复时间和苏醒时间差异无统计学意义（P > 0.05）。A组和B组的不良反应（恶心和呕吐）发生率显著低于C组（P < 0.05），但A组和B组之间差异无统计学意义（P > 0.05）。
最佳剂量为0.10μg·kg⁻¹·min⁻¹的瑞芬太尼可有效预防气管拔管时的心血管反应，并减少与麻醉相关的不良反应，且不延长恢复时间。
