围手术期极低剂量氯胺酮输注实际上会增加术后瑞芬太尼引起的寒战发生率——双盲随机试验。

Perioperative very low-dose ketamine infusion actually increases the incidence of postoperative remifentanil-induced shivering-double-blind randomized trial.

作者信息

Suzuki Manzo, Osumi Makoto, Shimada Hiromi, Bito Hiroyasu

机构信息

Department of Anesthesiology, Musashikosugi Hospital, Nippon Medical School, Kanagawa, Japan.

出版信息

Acta Anaesthesiol Taiwan. 2013 Dec;51(4):149-54. doi: 10.1016/j.aat.2013.12.003. Epub 2014 Jan 25.

DOI:10.1016/j.aat.2013.12.003

PMID:24529670

Abstract

INTRODUCTION

Low-dose ketamine infusion (blood concentration around 100 ng/mL) during surgery reduces the incidence of postoperative shivering after remifentanil-based anesthesia. We hypothesized that perioperative infusion of very low-dose ketamine (blood concentration around 40 ng/mL) during remifentanil-based anesthesia may also prevent the development of remifentanil-induced shivering during the 2-hour period after the end of anesthesia.

MATERIALS AND METHODS

Fifty female patients scheduled to undergo laparoscopic cystectomy or oophorectomy were assigned to one of two groups: (1) ketamine group, in which the patients received ketamine infusion (0.1 mg/kg/hour) from induction of anesthesia to emergence from anesthesia; and (2) control group, in which the patients received saline infusion from induction up till emergence from anesthesia. Anesthesia was induced and maintained by target-controlled infusion of propofol (estimated blood concentration: 2-4 μg/mL) and infusion of remifentanil, at 0.2-0.3 μg/kg/minute. Patients were observed for shivering from the end of anesthesia to 120 minutes after anesthesia. The time point at which the patient began to shiver was recorded and assigned to one of four time periods: at emergence, from emergence to 30 minutes after anesthesia, from 30 minutes to 60 minutes after anesthesia, and >60 minutes after anesthesia.

RESULTS

During the 120-minute observation period, the number of patients who shivered was higher in the ketamine group than the in control group (18 vs. 8, ketamine group vs. control group, p = 0.01). The time period during which patients began to shiver was different between the two groups (1 patient, 4 patients, and 13 patients vs. 3 patients, 2 patients, and 3 patients at emergence, from emergence to 30 minutes, and from 30 minutes to 60 minutes after anesthesia, respectively; ketamine group vs. control group, p = 0.007).

CONCLUSION

Intraoperative infusion of very low-dose ketamine during remifentanil-based anesthesia may increase the incidence of postoperative shivering.

摘要

引言

手术期间输注低剂量氯胺酮（血药浓度约100 ng/mL）可降低瑞芬太尼麻醉后术后寒战的发生率。我们推测，在瑞芬太尼麻醉期间围手术期输注极低剂量氯胺酮（血药浓度约40 ng/mL）也可能预防麻醉结束后2小时内瑞芬太尼诱发的寒战。

材料与方法

50例计划行腹腔镜膀胱切除术或卵巢切除术的女性患者被分为两组：（1）氯胺酮组，患者从麻醉诱导至麻醉苏醒期间接受氯胺酮输注（0.1 mg/kg/小时）；（2）对照组，患者从麻醉诱导至麻醉苏醒期间接受生理盐水输注。通过靶控输注丙泊酚（估计血药浓度：2 - 4 μg/mL）和以0.2 - 0.3 μg/kg/分钟的速度输注瑞芬太尼诱导并维持麻醉。观察患者从麻醉结束至麻醉后120分钟的寒战情况。记录患者开始寒战的时间点，并分为四个时间段之一：苏醒时、苏醒至麻醉后30分钟、麻醉后30分钟至60分钟以及麻醉后>60分钟。

结果

在120分钟的观察期内，氯胺酮组寒战患者数量高于对照组（18例 vs. 8例，氯胺酮组 vs. 对照组，p = 0.01）。两组患者开始寒战的时间段不同（苏醒时分别为1例、4例和13例 vs. 3例、2例和3例，苏醒至麻醉后30分钟，以及麻醉后30分钟至60分钟，氯胺酮组 vs. 对照组，p = 0.007）。