Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
University of Ulsan College of Medicine, Seoul, South Korea.
Minerva Anestesiol. 2018 May;84(5):546-555. doi: 10.23736/S0375-9393.17.12065-1. Epub 2017 Sep 11.
The aim of this study was to evaluate the analgesic potency dose of remifentanil to maintain Surgical Pleth Index (SPI) values at less than 50 after intubation in patients undergoing general anesthesia with target-controlled infusion of propofol and remifentanil.
We randomly allocated 120 patients to receive one of three remifentanil target effect-site concentrations (5, 7, or 9 ng×mL-1) during intubation. The target effect-site concentrations of propofol were adjusted within a range of 2.5-3 μg×mL-1 to maintain bispectral index values at less than 60 during anesthesia induction. A reusable SPI sensor was placed on the index finger of the arm, and the SPI values were continuously recorded. The predicted probability for maintaining the SPI values at less than 50 after intubation against the cumulative amount of remifentanil was analyzed using logistic regression. The measurands were the baseline SPI value in patients without pain scheduled for surgery, and the maximal SPI value after intubation in patients receiving remifentanil with a target effect-site concentration of 7 ng×mL-1.
The estimated cumulative amount of remifentanil associated with a 50% and 95% probability of maintaining the SPI values at less than 50 after intubation were 135.0 µg and 330.4 µg, respectively. The estimated expanded uncertainty for the baseline and maximal SPI values after intubation in patients scheduled for surgery were 54.9±44.4 and 54.1±37.9, respectively, which corresponded to a confidence level of approximately 95%.
The analgesic potency dose of remifentanil to maintain SPI values at less than 50 after intubation was 135.0 µg.
本研究旨在评估瑞芬太尼的镇痛效力剂量，以维持接受依托咪酯和瑞芬太尼靶控输注全身麻醉患者的手术脉搏指数（SPI）值小于 50，以维持 SPI 值小于 50。
我们将 120 名患者随机分配接受三种瑞芬太尼靶效应室浓度（5、7 或 9 ng×mL-1）之一，在诱导麻醉期间，将依托咪酯的靶效应室浓度调整在 2.5-3 μg×mL-1 范围内，以维持脑电双频指数值小于 60。将可重复使用的 SPI 传感器放置在手臂的食指上，并连续记录 SPI 值。使用逻辑回归分析预测瑞芬太尼累积量对维持 SPI 值小于 50 的概率。测量值为无疼痛接受手术的患者的基础 SPI 值，以及接受 7 ng×mL-1 瑞芬太尼靶效应室浓度的患者在插管后的最大 SPI 值。
预测瑞芬太尼累积量与 SPI 值维持在 50 以下的 50%和 95%概率相关的量分别为 135.0µg 和 330.4µg。接受手术的患者的基础和插管后最大 SPI 值的估计扩展不确定度分别为 54.9±44.4 和 54.1±37.9，置信水平约为 95%。
瑞芬太尼的镇痛效力剂量为 135.0µg，以维持 SPI 值小于 50。
