Sato Tsunehisa, Kikura Mutsuhito, Sato Shigehito
Staff Anesthesiologist, Department of Anesthesiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan.
Chief in Anesthesiology, Department of Anesthesiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan.
J Opioid Manag. 2013 Sep-Oct;9(5):335-42. doi: 10.5055/jom.2013.0176.
To examine the characteristics of postoperative fentanyl effect-site concentrations during intravenous analgesia in patients requiring or not requiring a fentanyl bolus and in patients with or without postoperative nausea and vomiting (PONV).
Retrospective observational study.
University-affiliated general hospital.
Sixty patients who underwent posterior lumbar spine fusion.
The authors simulated the fentanyl effect-site concentration for 48 postoperative hours and compared it between patients who did and did not require a fentanyl bolus and between patients who did and did not experience PONV.
At the end of anesthesia, the fentanyl effect-site concentration was similar between 37 (61.7 percent) patients requiring and 23 (38.3 percent) patients not requiring a postoperative fentanyl bolus (p=0.97). Within the first 12 postoperative hours, the concentration decreased in both groups (p < 0.01). The fentanyl effect-site concentration was higher in patients requiring a postoperative fentanyl bolus (within 12 hours, 1.4 ± 0.32 ng/mL vs 0.89 ± 0.35 ng/mL; between 12 and 48 hours, 0.94 ± 0.19 ng/mL vs 0.57 ± 0.09 ng/mL) (p < 0.05). PONV occurred in 22 (36.6 percent) patients, but more so in women (68.2 percent; p < 0.01); PONV was similar between patients requiring and not requiring a fentanyl bolus (p=0.78). Between the 12th and 48th postoperative hours, fentanyl effect-site concentrations were higher in patients with PONV (0.61 ± 0.10 ng/mL vs 0.57 ± 0.10 ng/mL, p=0.03).
Patients needing a postoperative fentanyl bolus require a higher fentanyl effect-site concentration possibly because of individual variations, and PONV depends on the postoperative fentanyl effect-site concentration.
研究在静脉镇痛期间，需要或不需要追加芬太尼推注的患者以及有或无术后恶心呕吐（PONV）的患者术后芬太尼效应室浓度的特征。
回顾性观察研究。
大学附属医院。
60例行腰椎后路融合术的患者。
作者模拟了术后48小时的芬太尼效应室浓度，并比较了需要和不需要追加芬太尼推注的患者之间以及发生和未发生PONV的患者之间的浓度。
麻醉结束时，37例（61.7%）需要术后芬太尼推注的患者与23例（38.3%）不需要术后芬太尼推注的患者之间的芬太尼效应室浓度相似（p = 0.97）。术后前12小时内，两组浓度均下降（p < 0.01）。需要术后芬太尼推注的患者芬太尼效应室浓度较高（12小时内，1.4±0.32 ng/mL对0.89±0.35 ng/mL；12至48小时，0.94±0.19 ng/mL对0.57±0.09 ng/mL）（p < 0.05）。22例（36.6%）患者发生PONV，但女性更多见（68.2%；p < 0.01）；需要和不需要追加芬太尼推注的患者之间PONV发生率相似（p = 0.78）。术后第12至48小时，发生PONV的患者芬太尼效应室浓度较高（0.61±0.10 ng/mL对0.57±0.10 ng/mL，p = 0.03）。
需要术后追加芬太尼推注的患者可能由于个体差异需要更高的芬太尼效应室浓度，且PONV取决于术后芬太尼效应室浓度。
