Hosseinzadeh Hamzeh, Eydi Mahmood, Ghaffarlou Mehdi, Ghabili Kamyar, Golzari Samad Ej, Bazzazi Amir Mohammad
Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran.
J Cardiovasc Thorac Res. 2012;4(1):21-4. doi: 10.5681/jcvtr.2012.005. Epub 2012 Feb 17.
Emergence from general anesthesia and especially post-extubation phase are the stages associated with cardiovascular hyperdynamic status in which patients with increased intracranial pressure (ICP) could be affected by severe cardiac and or cerebral complications. Administering remifentanil could be helpful in maintaining the hemodynamic stability at the end of the surgery and recovery stages and reducing recovery phase length.
In a double-blind prospective randomized clinical trial, 60 adult patients with ASA (American Society of Anesthesiologist) class of I-II scheduled to undergo elective neurosurgery operations were randomly divided into two groups receiving remifentanil and placebo as IV infusion within four minutes prior to extubation continued by an IV infusion for 10 minutes after extubation.
There was a significant difference between two groups regarding the changes of Mean Arterial Pressure after extubation and five minutes after extubation (P˂ 0.001).Remifentanil group compared with control group was of significant difference at all heart rate values after extubation (P< 0.001).
Remifentanil could be used in preventing hyperdynamic status throughout extubation phase without extending recovery phase length. However, administration of this medication should be performed cautiously.
全身麻醉苏醒期，尤其是拔管后阶段，与心血管高动力状态相关，在此阶段，颅内压（ICP）升高的患者可能会受到严重心脏和/或脑部并发症的影响。使用瑞芬太尼有助于在手术结束和恢复阶段维持血流动力学稳定，并缩短恢复阶段时长。
在一项双盲前瞻性随机临床试验中，60例计划接受择期神经外科手术的ASA（美国麻醉医师协会）I-II级成年患者被随机分为两组，在拔管前4分钟内静脉输注瑞芬太尼和安慰剂，并在拔管后持续静脉输注10分钟。
两组在拔管后及拔管后5分钟平均动脉压的变化方面存在显著差异（P˂0.001）。瑞芬太尼组与对照组相比，拔管后所有心率值均存在显著差异（P<0.001）。
瑞芬太尼可用于预防整个拔管阶段的高动力状态，且不延长恢复阶段时长。然而，使用此药物时应谨慎。
