作为七氟醚、丙泊酚和瑞芬太尼麻醉效能的一般指标，预测喉镜耐受和有害刺激反应指数的可能性。

Probability to tolerate laryngoscopy and noxious stimulation response index as general indicators of the anaesthetic potency of sevoflurane, propofol, and remifentanil.

机构信息

Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.

Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands

出版信息

Br J Anaesth. 2016 May;116(5):624-31. doi: 10.1093/bja/aew060.

DOI:10.1093/bja/aew060

PMID:27106965

Abstract

BACKGROUND

The probability to tolerate laryngoscopy (PTOL) and its derivative, the noxious stimulation response index (NSRI), have been proposed as measures of potency of a propofol-remifentanil drug combination. This study aims at developing a triple drug interaction model to estimate the combined potency of sevoflurane, propofol, and remifentanil in terms of PTOL. We compare the predictive performance of PTOL and the NSRI with various anaesthetic depth monitors.

METHODS

Data from three previous studies (n=120) were pooled and reanalysed. Movement response after laryngoscopy was observed with different combinations of propofol-remifentanil, sevoflurane-propofol, and sevoflurane-remifentanil. A triple interaction model to estimate PTOL was developed. The NSRI was derived from PTOL. The ability of PTOL and the NSRI to predict observed tolerance of laryngoscopy (TOL) was compared with the following other measures: (i) effect-site concentrations of sevoflurane, propofol, and remifentanil (CeSEVO, CePROP, and CeREMI); (ii) bispectral index; (iii) two measures of spectral entropy; (iv) composite variability index; and (v) surgical pleth index.

RESULTS

Sevoflurane and propofol interact additively, whereas remifentanil interacts in a strongly synergistic manner. The effect-site concentrations of sevoflurane and propofol at a PTOL of 50% (Ce50; se) were 2.59 (0.13) vol % and 7.58 (0.49) µg ml(-1). A CeREMI of 1.36 (0.15) ng ml(-1) reduced the Ce50 of sevoflurane and propofol by 50%. The common slope factor was 5.22 (0.52). The PTOL and NSRI predict the movement response to laryngoscopy best.

CONCLUSIONS

The triple interaction model estimates the potency of any combination of sevoflurane, propofol, and remifentanil expressed as either PTOL or NSRI.

摘要

背景

在喉镜检查中的耐受概率（PTOL）及其衍生的有害刺激反应指数（NSRI）被提出作为评估丙泊酚-瑞芬太尼药物组合效能的指标。本研究旨在建立一个三药相互作用模型，以评估七氟醚、丙泊酚和瑞芬太尼联合用药时对 PTOL 的综合效能。我们比较了 PTOL 和 NSRI 与各种麻醉深度监测仪的预测性能。

方法

汇总并重新分析了来自三项先前研究（n=120）的数据。在不同的丙泊酚-瑞芬太尼、七氟醚-丙泊酚和七氟醚-瑞芬太尼组合中观察喉镜检查后的运动反应。建立了一个估计 PTOL 的三药相互作用模型。从 PTOL 中得出了 NSRI。比较了 PTOL 和 NSRI 预测观察到的喉镜检查耐受性（TOL）的能力与以下其他指标：（i）七氟醚、丙泊酚和瑞芬太尼的效应部位浓度（CeSEVO、CePROP 和 CeREMI）；（ii）脑电双频指数；（iii）两种谱熵测量值；（iv）综合变异性指数；以及（v）手术 pleth 指数。

结果

七氟醚和丙泊酚呈相加性相互作用，而瑞芬太尼呈强协同性相互作用。PTOL 为 50%时（Ce50；se）的七氟醚和丙泊酚效应部位浓度分别为 2.59（0.13）vol%和 7.58（0.49）μg ml(-1)。CeREMI 为 1.36（0.15）ng ml(-1)时，可使七氟醚和丙泊酚的 Ce50 降低 50%。共同斜率因子为 5.22（0.52）。PTOL 和 NSRI 对预测喉镜检查的运动反应最佳。