Choi Yi Hwa, Kim Kyung Mi, Lee Soo Kyung, Kim Yi Seul, Kim Seon Ju, Hwang Woon Suk, Chung Jin Huan
Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro, 170 beon-gil, Dongan-gu, Anyang, 431-796, Republic of Korea.
Department of Anesthesiology and Pain Medicine, College of Medicine, Kangwon National University, Chuncheon, 200-701, Republic of Korea.
BMC Anesthesiol. 2016 Aug 2;16(1):50. doi: 10.1186/s12871-016-0213-2.
Sevoflurane is commonly usedin pediatric anesthesia due to its non-irritating airway properties, and rapid induction and emergence. However, it is associated with emergence agitation (EA) in children. EA may cause injury to the child or damage to the surgical site and is a cause of stress to both caregivers and families. The efficacy of remifentanil and additional alfentanil on EA in the pediatric patients underwent ophthalmic surgery with sevofluraneanesthesiawas not well evaluated to date. This study was designed to compare the effects of remifentanil and remifentanil plus alfentanil on EA in children undergoing ophthalmic surgery with sevofluraneanesthesia.
Children (aged 3-9 years) undergoing ophthalmic surgery undersevoflurane anesthesia were randomly assigned to group S (sevoflurane alone), group R (sevofluraneandremifentanil infusion, 0.1 μg/kg/min), or group RA (sevoflurane withremifentanil infusion and intravenous injection of alfentanil 5 μg/kg 10 min before the end of surgery). Mean arterial pressure (MAP), heart rate (HR), and sevoflurane concentration were checked every 15 min after induction of anesthesia. The incidence of EA, time to extubation from discontinuation of sevoflurane inhalation, and time to discharge from the postanesthesia care unit was assessed.
The incidence of EA was significantly lower in groups R (32 %, 11/34; P = 0.01) and RA (31 %, 11/35; P = 0.008) than group S (64 %, 21/33). The time to extubation was prolonged in group RA (11.2 ± 2.3 min; P = 0.004 and P = 0.016) compared with groups S (9.2 ± 2.3 min) andR (9.5 ± 2.4 min). MAP and HR were similar in all three groups, apart from a reduction in HR at 45 min in groups R and RA. However, the sevoflurane concentration was lower in groups R and RA than group S (P < 0.001).
The administration of remifentanil to children undergoing ophthalmic surgery undersevoflurane anesthesia reduced the incidence of EA without clinically significant hemodynamic changes. However, the addition of alfentanil(5 μg/kg)10 min before the end of surgery provided no additional benefit compared withremifentanil alone.
NCT02486926 , June.29.2015.
七氟醚因其对气道无刺激性、诱导和苏醒迅速，常用于小儿麻醉。然而，它与小儿苏醒期躁动（EA）有关。EA可能导致患儿受伤或手术部位受损，给护理人员和家庭带来压力。迄今为止，瑞芬太尼和额外的阿芬太尼对接受七氟醚麻醉的眼科手术小儿患者EA的疗效尚未得到充分评估。本研究旨在比较瑞芬太尼和瑞芬太尼加阿芬太尼对接受七氟醚麻醉的眼科手术小儿患者EA的影响。
接受七氟醚麻醉的眼科手术患儿（3 - 9岁）被随机分为S组（仅用七氟醚）、R组（七氟醚加瑞芬太尼输注，0.1μg/kg/min）或RA组（七氟醚加瑞芬太尼输注并在手术结束前10分钟静脉注射阿芬太尼5μg/kg）。麻醉诱导后每15分钟检查平均动脉压（MAP）、心率（HR）和七氟醚浓度。评估EA的发生率、停止吸入七氟醚后的拔管时间以及麻醉后护理单元的出院时间。
R组（32%，11/34；P = 0.01）和RA组（31%，11/35；P = 0.008）的EA发生率显著低于S组（64%，21/33）。与S组（9.2±2.3分钟）和R组（9.5±2.4分钟）相比，RA组的拔管时间延长（11.2±2.3分钟；P = 0.004和P = 0.016）。除R组和RA组在45分钟时心率降低外，三组的MAP和HR相似。然而，R组和RA组的七氟醚浓度低于S组（P < 0.001）。
对接受七氟醚麻醉的眼科手术患儿给予瑞芬太尼可降低EA的发生率，且无临床显著的血流动力学变化。然而，与单独使用瑞芬太尼相比，在手术结束前10分钟添加阿芬太尼（5μg/kg）并未带来额外益处。
NCT02486926，2015年6月29日。
