Koh Gi-Ho, Jung Ki Tae, So Keum Young, Seo Jong Sik, Kim Sang Hun
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul.
Department of Anesthesiology and Pain Medicine, Chosun University Hospital.
Medicine (Baltimore). 2019 May;98(18):e15509. doi: 10.1097/MD.0000000000015509.
Intubation using direct laryngoscopy is a risky and painful procedure that is associated with undesirable hemodynamic changes such as tachycardia, hypertension, and arrhythmia. Recently, intravenous oxycodone was introduced and used for the control of acute postoperative pain and to attenuate intubation-related hemodynamic responses (IRHRs), but there is insufficient information regarding its proper dosage. We investigated the attenuating effects of different doses of oxycodone and fentanyl on IRHRs.
For calculating oxycodone effective dose (ED95), which attenuated all IRHR changes to less than 20% over baseline values in 95% of male patients at 1 minute after intubation, oxycodone 0.1 mg/kg was injected for the first patient 1 hour before intubation, and the next dose for each subsequent patient was determined by the response of the previous patient using Dixon up-and-down method with an interval of 0.01 mg/kg. After obtaining the predictive oxycodone ED95, 148 patients were randomly allocated to groups receiving normal saline (group C), oxycodone ED95 (group O1), oxycodone 2 × ED95 (group O2), or fentanyl 2 μg/kg (group F). We recorded the incidence of "success" as a less than 20% change from baseline values in all IRHRs 1 minute after intubation.
The predictive oxycodone ED95 was 0.091 (0.081-0.149) mg/kg. The incidence of "success" was highest in group O2 (75.7%), followed by group O1 (62.2%) and group F (45.9%) with significant differences between the groups (P < .001). The systolic, diastolic, mean arterial pressure, and heart rate were not significantly different among groups after administration of either oxycodone or fentanyl. The percentage hemodynamic changes of the group O2 were significantly lower than those of groups F and O1, but the absolute percentage hemodynamic changes were not significantly different among groups F, O1, and O2. The recalculated oxycodone ED95 with probit analysis (0.269 mg/kg) was needed to prevent any arterial pressure and heart rate changes.
Oxycodone 0.182 mg/kg is more effective in attenuating all IRHRs than fentanyl 2 μg/kg with safe hemodynamic changes. Further research is required to determine if the recalculated oxycodone ED95 (0.269 mg/kg) is also effective and hemodynamically safe for preventing all IRHRs.
使用直接喉镜插管是一种有风险且痛苦的操作，会引发不良的血流动力学变化，如心动过速、高血压和心律失常。最近，静脉注射羟考酮被引入并用于控制术后急性疼痛以及减轻插管相关的血流动力学反应（IRHRs），但其合适剂量的信息不足。我们研究了不同剂量的羟考酮和芬太尼对IRHRs的减轻作用。
为计算羟考酮有效剂量（ED95），即能使95%的男性患者在插管后1分钟时所有IRHR变化相对于基线值减少至低于20%，在插管前1小时给第一名患者注射0.1mg/kg羟考酮，随后每名患者的下一剂量根据前一名患者的反应，采用Dixon上下法，以0.01mg/kg的间隔确定。获得预测的羟考酮ED95后，148名患者被随机分配至接受生理盐水的组（C组）、羟考酮ED95组（O1组）、羟考酮2×ED95组（O2组）或芬太尼2μg/kg组（F组）。我们将插管后1分钟时所有IRHR相对于基线值变化小于20%记录为“成功”发生率。
预测的羟考酮ED95为0.091（0.081 - 0.149）mg/kg。“成功”发生率在O2组最高（75.7%），其次是O1组（62.2%）和F组（45.9%），组间差异有统计学意义（P <.001）。给予羟考酮或芬太尼后，各组间收缩压、舒张压、平均动脉压和心率无显著差异。O2组的血流动力学变化百分比显著低于F组和O1组，但F组、O1组和O2组的绝对血流动力学变化百分比无显著差异。采用概率分析重新计算的羟考酮ED95（0.269mg/kg）可预防任何动脉压和心率变化。
0.182mg/kg的羟考酮在减轻所有IRHRs方面比2μg/kg的芬太尼更有效，且血流动力学变化安全。需要进一步研究以确定重新计算的羟考酮ED95（0.269mg/kg）在预防所有IRHRs方面是否也有效且血流动力学安全。
