Tak Yang Ju, Park Sang Hi, Kim Sang Tae
Department of Anesthesiology and Pain Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea.
Korean J Anesthesiol. 2009 Aug;57(2):155-160. doi: 10.4097/kjae.2009.57.2.155.
Propofol produces anesthesia with rapid recovery but also causes pain on injection. This study was designed to evaluate the effects of two different concentrations of remifentanil for minimizing the pain caused by propofol and to compare the hemodynamic changes during propofol-remifentanil infusion.
In a randomized, double-blind study of 80 patients, we compared the severity of the injection pain of propofol between two groups of patients. The initial effect-site target concentration of remifentanil was set at 4 ng/ml (the R4 group, n = 40) or 8 ng/ml (the R8 group, n = 40). After the effect-site concentration of remifentanil was achieved, the infusion of propofol was started with the concentration of 4 microgram/ml. The remifentanil-related complications were evaluated and the severity of the pain caused by propofol was compared by using a four-point scale during the propofol infusion. The heart rate and arterial blood pressure were measured at pre-induction, just before intubation and at 1 minute after intubation.
The severity of injection pain of propofol was significantly lower in the R8 group than in the R4. There was no significant difference in the incidence of remifentanil-related complications between the two groups. Compared with the pre-induction values, the heart rate and arterial blood pressure were significantly lower at pre-intubation and at 1 minute after intubation in the R4 and R8 groups.
Pretreatment with an effect-site concentration of 8 ng/ml remifentanil may be useful for minimizing the propofol injection pain compared with 4 ng/ml remifentanil.
丙泊酚可产生快速苏醒的麻醉效果，但注射时也会引起疼痛。本研究旨在评估两种不同浓度瑞芬太尼对减轻丙泊酚所致疼痛的效果，并比较丙泊酚-瑞芬太尼输注期间的血流动力学变化。
在一项对80例患者的随机双盲研究中，我们比较了两组患者丙泊酚注射疼痛的严重程度。瑞芬太尼的初始效应室靶浓度设定为4 ng/ml（R4组，n = 40）或8 ng/ml（R8组，n = 40）。在达到瑞芬太尼效应室浓度后，以4微克/毫升的浓度开始输注丙泊酚。评估瑞芬太尼相关并发症，并在丙泊酚输注期间使用四点量表比较丙泊酚所致疼痛的严重程度。在诱导前、插管前及插管后1分钟测量心率和动脉血压。
R8组丙泊酚注射疼痛的严重程度显著低于R4组。两组瑞芬太尼相关并发症的发生率无显著差异。与诱导前值相比，R4组和R8组在插管前及插管后1分钟时心率和动脉血压显著降低。
与4 ng/ml瑞芬太尼相比，效应室浓度为8 ng/ml瑞芬太尼预处理可能有助于减轻丙泊酚注射疼痛。
