瑞芬太尼与阿芬太尼在腹腔镜胆囊切除术患者全凭静脉麻醉中的随机双盲对照研究。

Randomized double-blind comparison of remifentanil and alfentanil in patients undergoing laparoscopic cholecystectomy using total intravenous anesthesia.

作者信息

Beleña José M, Núñez Mónica, Vidal Alfonso, Anta Diego

机构信息

Department of Anaesthesiology and Critical Care, Hospital Sur, Alcorcón, Madrid, Spain; Department of Pharmacology, Anaesthesiology and Resuscitation Unit, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain.

Department of Anaesthesiology and Critical Care, Hospital Sur, Alcorcón, Madrid, Spain.

出版信息

J Anaesthesiol Clin Pharmacol. 2016 Oct-Dec;32(4):487-491. doi: 10.4103/0970-9185.173368.

DOI:10.4103/0970-9185.173368

PMID:28096580

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5187614/

Abstract

BACKGROUND AND AIMS

To compare the use of remifentanil and alfentanil to suppress intraoperative adrenergic response of pain and the influence of these drugs on the recovery profile in patients undergoing laparoscopic cholecystectomy using a total intravenous anesthesia (TIVA) technique.

MATERIAL AND METHODS

One hundred patients undergoing elective laparoscopic cholecystectomy were randomized to be managed with either remifentanil (group R) or alfentanil (group A). During general anesthesia, we evaluated adrenergic responses to intubation to first surgical incision and over the surgical procedure. We also recorded time to first spontaneous breathing, time to successful ventilation, time to respond to verbal orders, and time to extubation.

RESULTS

The R group reported a significantly lower number of responses to intubation and responses to first surgical incision (14% vs. 30%; = 0.013 and 8% vs. 18%; = 0,037, respectively). The event of one or more responses during the surgical procedure was also lower in the R group (56% vs. 70%; = 0.017). Hypertensive response to surgical stimuli during the procedure was lower in the R group as well as a lower frequency of tachycardia episodes in this group (34% vs. 56%; = 0.033 and 28% vs. 44%; = 0.041, respectively). No differences were found between groups relating to the percentage of hypotensive episodes and no episodes of bradycardia were appreciated. Both groups were similar relating to recovery times: time to the first spontaneous breathing, time to successful ventilation, time to respond to verbal orders, and time to extubation.

CONCLUSION

Remifentanil showed a more stable hemodynamic response during the surgery compared with the use of alfentanil in anesthetized patients undergoing laparoscopic cholecystectomy using TIVA. Both opioids, alfentanil and remifentanil, have a similar recovery profile, and they do not delay time to awakening.

摘要

背景与目的

比较瑞芬太尼和阿芬太尼在采用全静脉麻醉（TIVA）技术的腹腔镜胆囊切除术患者中抑制术中疼痛所致肾上腺素能反应的效果以及这些药物对恢复情况的影响。

材料与方法

100例行择期腹腔镜胆囊切除术的患者被随机分为两组，分别接受瑞芬太尼治疗（R组）或阿芬太尼治疗（A组）。在全身麻醉期间，我们评估了从气管插管至首次手术切口以及整个手术过程中的肾上腺素能反应。我们还记录了首次自主呼吸时间、成功通气时间、对指令性言语做出反应的时间以及拔管时间。

结果

R组患者气管插管反应和首次手术切口反应的次数显著更低（分别为14%对30%；P = 0.013以及8%对18%；P = 0.037）。手术过程中出现一次或多次反应的情况在R组也更少（56%对70%；P = 0.017）。R组手术过程中对手术刺激的高血压反应更低，该组心动过速发作的频率也更低（分别为34%对56%；P = 0.033以及28%对44%；P = 0.041）。两组之间在低血压发作百分比方面未发现差异，且未观察到心动过缓发作。两组在恢复时间方面相似：首次自主呼吸时间、成功通气时间、对指令性言语做出反应的时间以及拔管时间。