Can J Anaesth. 2013 Dec;60(12):1204-11. doi: 10.1007/s12630-013-0040-6.
We hypothesized that nonsteroidal anti-inflammatory drugs decrease the plasma fentanyl concentration required to produce immobility in 50% of patients in response to skin incision (Cp50incision) compared with placebo under target-controlled infusion (TCI) propofol anesthesia.
Sixty-two unpremedicated patients scheduled to undergo gynecologic laparoscopy were randomly assigned to receive placebo (control group) or flurbiprofen axetil 1 mg·kg(-1) (flurbiprofen group) preoperatively. General anesthesia was induced with fentanyl and propofol, and intubation was performed after succinylcholine 1 mg·kg(-1). Propofol was administered via a target-controlled infusion (TCI) system (Diprifusor™) set at an effect-site concentration of 5 μg·mL(-1). Fentanyl was given by a TCI system using the STANPUMP software (Schafer model). The concentration for the first patient was set at 3 ng·mL(-1) and modified in each group according to the up-down method. Skin incision was performed after more than ten minutes equilibration time. Serum fentanyl concentration, bispectral index (BIS), and hemodynamic parameters were measured two minutes before and after skin incision. The Cp50incision of fentanyl was derived from the mean of the crossovers (i.e., the serum fentanyl concentrations of successive participants who responded and those who did not or vice versa).
Ten and 11 independent crossover pairs were collected in the control and flurbiprofen groups, respectively, representing 42 of 62 enrolled patients. The mean (SD) fentanyl Cp50incision was less in the flurbiprofen group [0.84 (0.63) ng·mL(-1)] than in the control group [1.65 (1.15) ng·mL(-1)]; P = 0.007; however, there were no differences in BIS, blood pressure, or heart rate, between groups.
Preoperative flurbiprofen axetil decreased the Cp50incision of fentanyl by 49% during propofol anesthesia without changing the BIS or hemodynamic variables.
我们假设与安慰剂相比，在依托咪酯靶控输注（TCI）麻醉下，非甾体抗炎药可降低接受皮肤切口时（Cp50incision）对 50%患者产生无反应的芬太尼血浆浓度（Cp50incision）。
62 例未接受术前用药的计划行妇科腹腔镜手术的患者随机分为接受安慰剂（对照组）或氟比洛芬酯 1mg·kg(-1)（氟比洛芬酯组）。全身麻醉诱导用芬太尼和依托咪酯，琥珀酰胆碱 1mg·kg(-1)后行气管插管。依托咪酯通过 Diprifusor™（Diprifusor™）靶控输注（TCI）系统输注，效应室浓度设定为 5μg·mL(-1)。芬太尼通过 STANPUMP 软件（Schafer 模型）的 TCI 系统给药。第一个患者的浓度设定为 3ng·mL(-1)，根据上下法在每组中进行修改。超过十分钟平衡时间后进行皮肤切口。在皮肤切口前后两分钟测量血清芬太尼浓度、双频谱指数（BIS）和血流动力学参数。芬太尼的 Cp50incision 是从交叉点的平均值（即对有反应和无反应的连续参与者或反之亦然的血清芬太尼浓度）得出的。
对照组和氟比洛芬酯组分别收集了 10 对和 11 对独立交叉对，分别代表 62 名入组患者中的 42 名。氟比洛芬酯组的芬太尼 Cp50incision 平均值（标准差）为 0.84（0.63）ng·mL(-1)，低于对照组的 1.65（1.15）ng·mL(-1)；P=0.007；然而，两组之间的 BIS、血压或心率无差异。
在依托咪酯麻醉期间，术前氟比洛芬酯可使芬太尼的 Cp50incision 降低 49%，而不改变 BIS 或血液动力学变量。
