Khidr Alaa M, Khalil Mohamed A, Abdulfattah Dalia, El Tahan Mohamed R
King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia.
King Fahd Hospital of the Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia; Faculty of Medicine, Cairo University, Cairo, Egypt.
J Cardiothorac Vasc Anesth. 2021 Feb;35(2):470-481. doi: 10.1053/j.jvca.2020.03.049. Epub 2020 Apr 19.
Assess different remifentanil effect-site concentrations (Ce) for readiness for extubation time after cardiac surgery.
Prospective, randomized, blinded, controlled study.
Single university hospital.
Seventy-three patients scheduled for cardiac surgery.
After ethical approval, patients scheduled for cardiac surgery with target-controlled propofol infusion were randomly assigned to receive remifentanil effect-site concentrations (Ce) of 1, 2, or 3 ng/mL (n = 25, 25, and 23, respectively).
The primary endpoint was readiness for extubation. Secondary outcomes were also recorded, including the cumulative doses and number of changes of propofol and remifentanil, hemodynamic variables, time to spontaneous eye opening and breathing, actual extubation, incidences of light anesthesia and myocardial ischemia, need for vasopressors and inotropes, and intensive care unit (ICU) and hospital stays. There was no difference in the time to readiness for extubation in any of the groups (0.1 ng/mL: 11.5 min (5-37); 0.2 ng/mL: 22 min (10-35); and 0.3 ng/mL: 21 min (10-49), p < 0.532); however, there was a significant difference among the 3 groups regarding the cumulative remifentanil doses (p < 0.001). Time to spontaneous eye opening and breathing, actual extubation, use of vasopressors and inotropes, incidences of light anesthesia and myocardial ischemia, and length of ICU and hospital stay were similar for all groups. Forty-six of the 73 patients were extubated on-table.
Remifentanil Ce 1, 2, and 3 ng/mL produced comparative effects on time to extubation and hemodynamic responses to cardiac surgery. The 3 Ce resulted in immediate on-table extubation in 50% of patients.
评估不同瑞芬太尼效应室浓度（Ce）对心脏手术后拔管准备时间的影响。
前瞻性、随机、双盲、对照研究。
单一大学医院。
73例计划进行心脏手术的患者。
经伦理批准后，计划接受靶控丙泊酚输注进行心脏手术的患者被随机分配接受1、2或3 ng/mL的瑞芬太尼效应室浓度（Ce）（分别为n = 25、25和23）。
主要终点是拔管准备情况。还记录了次要结局，包括丙泊酚和瑞芬太尼的累积剂量及变化次数、血流动力学变量、自主睁眼和呼吸时间、实际拔管情况、浅麻醉和心肌缺血的发生率、血管升压药和正性肌力药的使用需求以及重症监护病房（ICU）住院时间和住院时间。各组在拔管准备时间上无差异（0.1 ng/mL：11.5分钟（5 - 37）；0.2 ng/mL：22分钟（10 - 35）；0.3 ng/mL：21分钟（10 - 49），p < 0.532）；然而，3组之间瑞芬太尼累积剂量存在显著差异（p < 0.001）。所有组的自主睁眼和呼吸时间、实际拔管情况、血管升压药和正性肌力药的使用、浅麻醉和心肌缺血的发生率以及ICU住院时间和住院时间相似。73例患者中有46例在手术台上拔管。
1、2和3 ng/mL的瑞芬太尼Ce对心脏手术拔管时间和血流动力学反应产生了相似的影响。这3种Ce浓度使50%的患者在手术台上立即拔管。
