痛觉导向与瑞芬太尼-丙泊酚麻醉期间的标准护理：一项随机对照试验。
Nociception-guided versus Standard Care during Remifentanil-Propofol Anesthesia: A Randomized Controlled Trial.
机构信息
From the Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
出版信息
Anesthesiology. 2019 May;130(5):745-755. doi: 10.1097/ALN.0000000000002634.
BACKGROUND
The multidimensional index of nociception, the nociception level, outperforms blood pressure and heart rate in detection of nociceptive events during anesthesia. We hypothesized that nociception level-guided analgesia reduces opioid consumption and suboptimal anesthesia events such as low blood pressure and use of vasoactive medication.
METHODS
In this single-blinded randomized study, 80 American Society of Anesthesiologists class I-III adult patients of either sex, scheduled for major abdominal procedures under remifentanil/propofol anesthesia by target-controlled infusion, were included. During the procedure nociception level, noninvasive blood pressure, and heart rate were monitored. Patients were randomized to receive standard clinical care or nociception level-guided analgesia. In the nociception level-guided group, remifentanil concentration was reduced when index values were less than 10 or increased when values were above 25 for at least 1 min, in steps of 0.5 to 1.0 ng/ml. Propofol was titrated to bispectral index values between 45 and 55. The primary outcomes of the study were remifentanil and propofol consumption and inadequate anesthesia events.
RESULTS
Compared with standard care, remifentanil administration was reduced in nociception level-guided patients from (mean ± SD) 0.119 ± 0.033 to 0.086 ± 0.032 μg · kg · min (mean difference, 0.039 μg · kg · min; 95% CI, 0.025-0.052 μg · kg · min; P < 0.001). Among nociception level-guided patients, 2 of 40 (5%) experienced a hypotensive event (mean arterial pressure values less than 55 mm Hg) versus 11 of 40 (28%) patients in the control group (relative risk, 0.271; 95% CI, 0.08-0.77; P = 0.006). In the nociception level-guided group, 16 of 40 (40%) patients received vasoactive medication versus 25 of 40 (63%) patients in the standard care group (relative risk, 0.64; 95% CI, 0.40-0.99; P = 0.044).
CONCLUSIONS
Nociception level-guided analgesia during major abdominal surgery resulted in 30% less remifentanil consumption.
背景
多维度痛觉指数（痛觉水平）在检测麻醉期间的痛觉事件方面优于血压和心率。我们假设痛觉水平指导的镇痛可以减少阿片类药物的消耗和低血压等不理想的麻醉事件，以及血管活性药物的使用。
方法
在这项单盲随机研究中，纳入了 80 名美国麻醉医师学会（ASA）分级 I-III 级的成年患者，无论性别如何，均接受瑞芬太尼/丙泊酚靶控输注下的大型腹部手术，监测术中痛觉水平、无创血压和心率。患者随机接受标准临床护理或痛觉水平指导的镇痛。在痛觉水平指导组中，当指数值低于 10 或高于 25 至少 1 分钟时，以 0.5 至 1.0ng/ml 的步长减少瑞芬太尼浓度，以至少 1 分钟为单位。将丙泊酚滴定至脑电双频指数值在 45 至 55 之间。该研究的主要结局是瑞芬太尼和丙泊酚的消耗和不理想的麻醉事件。
结果
与标准护理相比，痛觉水平指导组患者的瑞芬太尼给药量从（平均值±标准差）0.119±0.033μg·kg·min 减少至 0.086±0.032μg·kg·min（平均差值 0.039μg·kg·min；95%置信区间 0.025-0.052μg·kg·min；P＜0.001）。在痛觉水平指导组中，有 2 名患者（5%）发生低血压事件（平均动脉压值低于 55mmHg），而对照组中有 11 名患者（28%）发生低血压事件（相对风险 0.271；95%置信区间 0.08-0.77；P=0.006）。在痛觉水平指导组中，有 16 名患者（40%）接受了血管活性药物治疗，而对照组中有 25 名患者（63%）接受了血管活性药物治疗（相对风险 0.64；95%置信区间 0.40-0.99；P=0.044）。
结论
在大型腹部手术中，痛觉水平指导的镇痛可使瑞芬太尼消耗减少 30%。
Zotero 插件