Kwon O Sun, Lee Hyeon Jeong, Yoon Ji Young, Kim Cheul Hong, Kwon Jae Young, Kim Hae Kyu
Department of Anesthesiology and Pain Medicine, Pusan National University School of Medicine, College of Dentistry, Graduate School, Pusan National University, Busan, Korea.
Korean J Anesthesiol. 2009 Nov;57(5):604-609. doi: 10.4097/kjae.2009.57.5.604.
Remifentanil is a useful opioid, but it induces postoperative hyperalgesia and acute tolerance associated N-methyl-D-aspartate (NMDA) receptor. This study was aimed to investigate whether small dose ketamine, NMDA receptor antagonist, prevent remifentanil induced postoperative hyperalgesia or acute tolerance after combined anesthesia with propofol and remifentanil using target controlled infusion (TCI) in patients undergoing mastectomy.
Fourty ASA physical status 1 or 2 women, undergoing mastectomy were randomly assigned to two groups to receive intraoperative infusion of ketamine at 3microgram/kg/min rate after injection of ketamine 0.3 mg/kg as a loading dose (Group K) or saline infusion after saline loading at the same rate and dose (Group C). All the patients were anesthetized with propofol and remifentanil to maintain bispectral index (BIS) 40-60, mean arterial pressure within 20% of basal values. Remifentanil was infused with target controlled infusion (TCI) to the effect site (concentration: 2.0 ng/ml). Postoperative paine scores (visual analog scale: VAS), morphine requirements, and sedation scores were recorded for 48 hours postoperatively.
The VAS scores and morphine requirements of the Group K were significantly lower than those of the Group C at the postanesthetic care unit and at the ward for 24 hours postoperatively. The extubation time was delayed in Group K compared with Group C.
Intraoperative infusion of small dose ketamine reduced postoperative pain and morphine requirements after combined anesthesia with propofol and remifentanil in patients undergoing mastectomy.
瑞芬太尼是一种有效的阿片类药物，但它会诱发术后痛觉过敏和与N-甲基-D-天冬氨酸（NMDA）受体相关的急性耐受。本研究旨在探讨NMDA受体拮抗剂小剂量氯胺酮是否能预防在接受乳房切除术的患者中使用丙泊酚和瑞芬太尼靶控输注（TCI）进行联合麻醉后瑞芬太尼诱发的术后痛觉过敏或急性耐受。
40例美国麻醉医师协会（ASA）身体状况为1或2级、接受乳房切除术的女性被随机分为两组，在静脉注射0.3mg/kg氯胺酮作为负荷剂量后，以3μg/（kg·min）的速率术中输注氯胺酮（K组），或以相同速率和剂量静脉注射生理盐水作为负荷剂量后输注生理盐水（C组）。所有患者均用丙泊酚和瑞芬太尼麻醉，维持脑电双频指数（BIS）在40 - 60，平均动脉压在基础值的20%以内。瑞芬太尼通过靶控输注（TCI）输注至效应部位（浓度：2.0ng/ml）。记录术后48小时的术后疼痛评分（视觉模拟评分法：VAS）、吗啡需求量和镇静评分。
术后24小时内，K组在麻醉后恢复室和病房的VAS评分及吗啡需求量显著低于C组。与C组相比，K组拔管时间延迟。
在接受乳房切除术的患者中，术中输注小剂量氯胺酮可减轻丙泊酚和瑞芬太尼联合麻醉后的术后疼痛和吗啡需求量。
