Radke Oliver C, Sippel Darja, Radke Katja, Hilgers Reinhard, Saur Petra
Department of Anesthesia and Perioperative Care, San Francisco General Hospital, University of California in San Francisco, San Francisco, USA ; Department of Anesthesia, University Hospital of Dresden, Dresden, Germany.
Department of Visceral Surgery and Medicine, University Hospital Bern, Inselspital, Switzerland.
Anesth Pain Med. 2014 Sep 3;4(4):e19278. doi: 10.5812/aapm.19278. eCollection 2014 Oct.
Sufentanil and alfentanil have pharmacokinetic and dynamic properties which make them favourable substances for total intravenous anesthesia (TIVA) in combination with propofol.
We planned to compare two clinical protocols for TIVA with propofol, and either sufentanil or alfentanil in regards to postoperative pain, hemodynamic stability during the case and time for emergence from anesthesia.
Treaty eight patients scheduled for general anesthesia for breast surgery were included in this Double-blind, randomized, controlled trial. All patients received a standardized TIVA with propofol and either 0.2 µg kg(-1) sufentanil or 20 µg kg(-1) alfentanil for induction and 0.3 µg kg(-1) h(-1) sufentanil or 30 µg kg(-1) h(-1) alfentanil for maintenance with additional propofol boluses as needed. During anesthesia, heart rate, non-invasive blood-pressure, peripheral oxygen saturation and depth of anesthesia, were recorded. In the post anesthesia care unit, pain scores, nausea and vomiting as well as medications were recorded.
Patients in the sufentanil group required less often additional opioid and propofol boluses to maintain adequate anesthesia. We did not observe a significant difference in time to extubation. Postoperatively, patients in the sufentanil group had less pain (P = 0.03) and required less i.v. opioids (0.4 vs. 1.9 mg piritramid, P = 0.04).
Both protocols provide excellent anesthesia, but patients receiving sufentnail had more stable anesthesia and less postoperative pain.
舒芬太尼和阿芬太尼具有药代动力学和药效学特性，使其成为与丙泊酚联合用于全静脉麻醉（TIVA）的理想药物。
我们计划比较两种丙泊酚联合舒芬太尼或阿芬太尼用于TIVA的临床方案，比较术后疼痛、术中血流动力学稳定性以及麻醉苏醒时间。
本双盲、随机、对照试验纳入了8例计划行乳腺手术全身麻醉的患者。所有患者均接受标准化的丙泊酚TIVA，诱导时给予0.2μg/kg舒芬太尼或20μg/kg阿芬太尼，维持时给予0.3μg·kg⁻¹·h⁻¹舒芬太尼或30μg·kg⁻¹·h⁻¹阿芬太尼，并根据需要追加丙泊酚 bolus。麻醉期间记录心率、无创血压、外周血氧饱和度和麻醉深度。在麻醉后护理单元，记录疼痛评分、恶心呕吐情况以及用药情况。
舒芬太尼组患者维持足够麻醉所需追加阿片类药物和丙泊酚 bolus的次数较少。我们未观察到拔管时间有显著差异。术后，舒芬太尼组患者疼痛较轻（P = 0.03），静脉注射阿片类药物用量较少（匹拉米洞0.4 vs. 1.9mg，P = 0.04）。
两种方案均能提供良好的麻醉效果，但接受舒芬太尼的患者麻醉更稳定，术后疼痛更轻。
