Won Young Ju, Lim Byung Gun, Yeo Gwi Eun, Lee Min Ki, Lee Dong Kyu, Kim Heezoo, Lee Il Ok, Kong Myoung Hoon
Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Medicine (Baltimore). 2017 Feb;96(6):e6154. doi: 10.1097/MD.0000000000006154.
The effectiveness of surgical pleth index (SPI) for managing nociception-antinociception balance during general anesthesia with vasodilators, including nicardipine has not been demonstrated. We aimed to compare the time course during surgery in SPI values in patients receiving nicardipine or remifentanil infusion during thyroidectomy.
Forty patients undergoing thyroidectomy were randomly assigned to receive nicardipine (group N; n = 19) or remifentanil (group R; n = 21) along with induction (propofol, fentanyl, and rocuronium) and maintenance (50% desflurane/nitrous oxide in oxygen) anesthesia (goal bispectral index [BIS] ∼50). The infusion of nicardipine or remifentanil was started before the 1st incision and adjusted to keep mean blood pressure (MBP) within ±20% of the preoperative value. SPI, BIS, end-tidal desflurane concentration (EtDes), MBP, and heart rate were recorded at 2.5 minute intervals from the 1st incision to the end of surgery. Extubation and recovery times, pain score/rescue ketorolac consumption, and adverse events in postanesthesia care unit (PACU) were recorded.
The trend of SPI during surgery was comparable between the 2 groups (P = 0.804), although the heart rates in group N were significantly higher than those in group R (P = 0.040). The patient characteristics, trends of BIS, EtDes, and MBP during surgery, extubation and recovery times, and incidence of nausea/vomiting were comparable between the groups. Group N had significantly lower pain scores and rescue ketorolac consumption at PACU.
SPI was comparable between patients receiving nicardipine or remifentanil infusion during thyroidectomy under general anesthesia, which suggests that the administration of nicardipine may confound the interpretation of SPI values during general anesthesia.
This trial was registered in the UMIN clinical trials registry (unique trial number: UMIN000019058; registration number: R000022028; principal investigator's name: Young Ju Won; date of registration: September 17, 2015).
手术体积描记指数（SPI）用于在包括尼卡地平在内的血管扩张剂全身麻醉期间管理伤害感受 - 抗伤害感受平衡的有效性尚未得到证实。我们旨在比较甲状腺切除术期间接受尼卡地平或瑞芬太尼输注的患者手术过程中SPI值的时间进程。
40例行甲状腺切除术的患者被随机分配接受尼卡地平（N组；n = 19）或瑞芬太尼（R组；n = 21），同时进行诱导（丙泊酚、芬太尼和罗库溴铵）和维持（50%地氟醚/氧化亚氮吸入氧）麻醉（目标脑电双频指数[BIS]约为50）。在第1个切口前开始输注尼卡地平或瑞芬太尼，并进行调整以保持平均血压（MBP）在术前值的±20%以内。从第1个切口至手术结束，每隔2.5分钟记录SPI、BIS、呼气末地氟醚浓度（EtDes）、MBP和心率。记录拔管和恢复时间、疼痛评分/补救性酮咯酸用量以及麻醉后监护病房（PACU）中的不良事件。
两组手术期间SPI的变化趋势相当（P = 0.804），尽管N组的心率显著高于R组（P = 0.040）。两组患者的特征、手术期间BIS、EtDes和MBP的变化趋势、拔管和恢复时间以及恶心/呕吐的发生率相当。N组在PACU的疼痛评分和补救性酮咯酸用量显著更低。
全身麻醉下甲状腺切除术期间接受尼卡地平或瑞芬太尼输注的患者之间SPI相当，这表明尼卡地平的使用可能会混淆全身麻醉期间SPI值的解读。
本试验在UMIN临床试验注册中心注册（唯一试验编号：UMIN000019058；注册号：R000022028；主要研究者姓名：Young Ju Won；注册日期：2015年9月17日）。
