Heo Bong Ha, Yoon Myung Ha, Lee Hyung Gon, Kim Woong Mo
Department of Anesthesiology and Pain Medicine, Chonnam National University, Medical School, Gwangju, Korea.
Korean J Anesthesiol. 2009 Jul;57(1):8-12. doi: 10.4097/kjae.2009.57.1.8.
This study was undertaken to determine the effect-site concentration of remifentanil for blunting hemodynamic responses to double lumen endobronchial intubation during target controlled infusion (TCI)-total intravenous anesthesia (TIVA) using 4.0 microg/ml of propofol with remifentanil.
Sixty patients (American society of anesthesiologists physical status classification 1 or 2) were randomly allocated according to the target effect-site concentration of remifentanil (R3.0: remifentanil 3.0 ng/ml; R3.5: remifentanil 3.5 ng/ml; R4.0: remifentanil 4.0 ng/ml). The effect-site concentration of propofol at loss of consciousness was recorded. Mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS) were recorded at just before remifentanil administration (baseline), at the time of target effect site concentration of remifentanil and propofol, at just before intubation and 1, 2, 3 min after intubation.
MAP was significantly increased compared with baseline at 1, 2 min after intubation in R3.0, but was significantly decreased in R4.0. MAP of R3.5 was not different from the baseline after intubation. HR was significantly decreased compared with baseline at the time of target effect site concentration of propofol and immediate before intubation in R3.5 and R4.0. After intubation, HR was significantly increased compared with baseline at only 1 min after intubation and returned to the baseline in R3.0. However, HR was continuously decreased in R4.0.
These findings suggest that effective target effect-site concentration of remifentanil for blunting hemodynamic responses to double lumen endotracheal intubation was 3.5 ng/ml during TCI-TIVA using 4.0 microgram/ml of propofol with remifentanil.
本研究旨在确定在使用4.0微克/毫升丙泊酚和瑞芬太尼的靶控输注（TCI）-全静脉麻醉（TIVA）期间，瑞芬太尼的效应室浓度对双腔支气管内插管血流动力学反应的抑制作用。
60例患者（美国麻醉医师协会身体状况分级为1或2级）根据瑞芬太尼的目标效应室浓度随机分配（R3.0：瑞芬太尼3.0纳克/毫升；R3.5：瑞芬太尼3.5纳克/毫升；R4.0：瑞芬太尼4.0纳克/毫升）。记录意识消失时丙泊酚的效应室浓度。在瑞芬太尼给药前（基线）、瑞芬太尼和丙泊酚达到目标效应室浓度时、插管前以及插管后1、2、3分钟记录平均动脉压（MAP）、心率（HR）和脑电双频指数（BIS）。
R3.0组插管后1、2分钟时MAP较基线显著升高，但R4.0组显著降低。R3.5组插管后MAP与基线无差异。在丙泊酚达到目标效应室浓度时以及R3.5和R4.0组插管前，HR较基线显著降低。插管后，仅在R3.0组插管后1分钟时HR较基线显著升高，随后恢复至基线。然而，R4.0组HR持续降低。
这些研究结果表明，在使用4.0微克/毫升丙泊酚和瑞芬太尼的TCI-TIVA期间，抑制双腔气管插管血流动力学反应的瑞芬太尼有效目标效应室浓度为3.5纳克/毫升。
