Jung Seungho, Na Sungwon, Kim Hye Bin, Joo Hye Ji, Kim Jeongmin
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Acute Crit Care. 2020 Aug;35(3):197-204. doi: 10.4266/acc.2020.00213. Epub 2020 Aug 10.
Although the use of volatile sedatives in the intensive care unit (ICU) is increasing in Europe, it remains infrequent in Asia. Therefore, there are no clinical guidelines available. This study investigates the proper initial concentration of sevoflurane, a volatile sedative that induces a Richmond agitation-sedation scale (RASS) score of -2 to -3, in patients who underwent head and neck surgery with tracheostomy. We also compared the amount of postoperative opioid consumption between volatile and intravenous (IV) sedation.
We planned a prospective study to determine the proper initial sevoflurane concentration and a retrospective analysis to compare postoperative opioid consumption between volatile sedation and propofol sedation. Patients scheduled for head and neck surgery with tracheostomy and subsequent postoperative sedation in the ICU were enrolled.
In this prospective study, the effective dose 50 (ED50) of initial end-tidal sevoflurane concentration was 0.36% (95% confidence interval [CI], 0.20 to 0.60%), while the ED 95 was 0.69% (95% CI, 0.60 to 0.75%) based on isotonic regression methods. In this retrospective study, remifentanil consumption during postoperative sedation was significantly lower in the sevoflurane group (2.52±1.00 µg/kg/hr, P=0.001) than it was in the IV propofol group (3.66±1.30 µg/kg/hr).
We determined the proper initial end-tidal concentration setting of sevoflurane for patients with tracheostomy who underwent head and neck surgery. Postoperative sedation with sevoflurane appears to be a valid and safe alternative to IV sedation with propofol.
尽管在欧洲重症监护病房（ICU）中挥发性镇静剂的使用正在增加，但在亚洲其使用仍然不常见。因此，目前尚无临床指南。本研究调查了在接受气管切开术的头颈外科手术患者中，能诱导里士满躁动镇静量表（RASS）评分为-2至-3的挥发性镇静剂七氟醚的合适初始浓度。我们还比较了挥发性镇静和静脉（IV）镇静之间术后阿片类药物的消耗量。
我们计划进行一项前瞻性研究以确定合适的七氟醚初始浓度，并进行回顾性分析以比较挥发性镇静和丙泊酚镇静之间术后阿片类药物的消耗量。纳入计划在ICU进行气管切开术及随后术后镇静的头颈外科手术患者。
在这项前瞻性研究中，基于等渗回归方法，初始呼气末七氟醚浓度的半数有效剂量（ED50）为0.36%（95%置信区间[CI]，0.20至0.60%），而ED95为0.69%（95%CI，0.60至0.75%）。在这项回顾性研究中，七氟醚组术后镇静期间瑞芬太尼的消耗量（2.52±1.00μg/kg/小时，P = 0.001）显著低于静脉丙泊酚组（3.66±1.30μg/kg/小时）。
我们确定了接受头颈外科手术的气管切开术患者七氟醚合适的初始呼气末浓度设置。七氟醚术后镇静似乎是丙泊酚静脉镇静的一种有效且安全的替代方法。
