瑞芬太尼抑制异丙酚麻醉期间 CO2 气腹反应的性别差异需求：上下序贯分配试验。
Effect of sex differences in remifentanil requirements for inhibiting the response to a CO pneumoperitoneum during propofol anesthesia: an up-and-down sequential allocation trial.
机构信息
Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230036, China.
Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230031, China.
出版信息
BMC Anesthesiol. 2020 Feb 3;20(1):35. doi: 10.1186/s12871-020-0951-z.
BACKGROUND
A CO pneumoperitoneum during a laparoscopic procedure causes violent hemodynamic changes. However, the remifentanil required to inhibit the cardiovascular response to a CO pneumoperitoneum combined with propofol remains unknown. Moreover, the sex of the patient may influence the response to opioids, which can affect this requirement. The main objective of this study was to compare the required median effective concentration (EC) of remifentanil for inhibiting the cardiovascular response to a CO pneumoperitoneum between female and male patients during propofol anesthesia.
METHODS
The current study is an up-and-down sequential allocation trial. Forty-six patients with American Society of Anesthesiologists physical status I or II, a body mass index 18 to 30 kg/m, aged 20 to 60 years, and scheduled for laparoscopic surgery were enrolled. Induction of anesthesia was performed by target-controlled infusion. The effective effect-site concentration (Ce) of propofol was 4 μg/ml. The Ce of remifentanil was initially 4 ng/ml and then adjusted to a predetermined level after I-gel laryngeal mask airway insertion. The Ce of remifentanil for each patient was determined by the response of the previous patient using the modified Dixon "up-and-down" method. The first patient received remifentanil at 5.0 ng/ml Ce, and the step size between patients was 0.5 ng/ml.
RESULTS
Patients characteristics including age, body mass index, American Society of Anesthesiologists physical status, type of surgery and surgery duration, were comparable between male and female patients. The EC of remifentanil required to inhibit the response to a CO pneumoperitoneum based on the Dixon "up-and-down" method in women (4.17 ± 0.38 ng/ml) was significantly lower than that in men (5.00 ± 0.52 ng/ml) during propofol anesthesia (P = 0.01).
CONCLUSIONS
The EC of remifentanil required to inhibit the response to a CO pneumoperitoneum was lower in women than in men during propofol anesthesia.
TRIAL REGISTRATION
The study was registered at http://www.chictr.org.cn (ChiCTR-IOR-17011906, 8th, July, 2017).
背景
腹腔镜手术中 CO 气腹会引起剧烈的血流动力学变化。然而，瑞芬太尼抑制 CO 气腹联合异丙酚引起的心血管反应所需的剂量尚不清楚。此外，患者的性别可能会影响对阿片类药物的反应，从而影响这一需求。本研究的主要目的是比较女性和男性患者在异丙酚麻醉期间抑制 CO 气腹引起的心血管反应所需的瑞芬太尼中位有效浓度（EC）。
方法
本研究为上下序贯分配试验。纳入 46 名美国麻醉医师协会（ASA）身体状况 I 或 II 级、体重指数 18 至 30kg/m2、年龄 20 至 60 岁、拟行腹腔镜手术的患者。采用靶控输注诱导麻醉。异丙酚效应室浓度（Ce）设定为 4μg/ml。瑞芬太尼 Ce 初始设定为 4ng/ml，然后在插入 I-gel 喉罩后根据前一位患者的反应调整至预定水平。采用改良 Dixon“上下”法确定每位患者的瑞芬太尼 Ce。第一位患者接受 5.0ng/ml 的瑞芬太尼 Ce，患者之间的步长为 0.5ng/ml。
结果
女性患者的年龄、体重指数、ASA 身体状况、手术类型和手术时间等特征与男性患者无差异。女性患者抑制 CO 气腹反应所需的瑞芬太尼 EC 值（4.17±0.38ng/ml）根据 Dixon“上下”法明显低于男性患者（5.00±0.52ng/ml）（P=0.01）。
结论
在异丙酚麻醉期间，女性抑制 CO 气腹反应所需的瑞芬太尼 EC 值低于男性。
试验注册
该研究在 http://www.chictr.org.cn（ChiCTR-IOR-17011906，2017 年 7 月 8 日）注册。
Zotero 插件