右美托咪定对伤害感受性指数指导下瑞芬太尼镇痛作用的影响：一项随机对照试验。
Effect of dexmedetomidine on Nociception Level Index-guided remifentanil antinociception: A randomised controlled trial.
机构信息
From the Department of Anaesthesiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium (SC, SD, LP, EE, LVO, LB), Department of Anaesthesiology, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium (SC, DP, LDM, PK), EW Data Analysis, Brussels, Belgium (EE), Department of Ear-Nose-Throat Surgery, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium (AR) and Department of Anaesthesiology, CHU Rennes, Université de Rennes, Rennes, France (JP-E).
出版信息
Eur J Anaesthesiol. 2021 May 1;38(5):524-533. doi: 10.1097/EJA.0000000000001402.
BACKGROUND
The effect of dexmedetomidine on Nociception Level Index-guided (Medasense, Israel) antinociception to reduce intra-operative opioid requirements has not been previously investigated.
OBJECTIVE
We aimed to determine if low-dose dexmedetomidine would reduce remifentanil requirements during Nociception Level Index-guided antinociception without increasing complications associated with dexmedetomidine.
DESIGN
Double-blind randomised controlled trial.
SETTING
Two university teaching hospitals in Brussels, Belgium.
PATIENTS
American Society of Anesthesiologists 1 and 2 patients (n = 58) undergoing maxillofacial or cervicofacial surgery under propofol--remifentanil target-controlled infusion anaesthesia.
INTERVENTIONS
A 30 min infusion of dexmedetomidine, or equal volume of 0.9% NaCl, was infused at 1.2 μg kg-1 h-1 immediately preceding induction and then decreased to 0.6 μg kg-1 h-1 until 30 min before ending surgery. Nociception Level Index and frontal electroencephalogram guided the remifentanil and propofol infusions, respectively.
MAIN OUTCOMES
The primary outcome was the remifentanil requirement. Other outcomes included the propofol requirement, cardiovascular status and postoperative outcome.
RESULTS
Mean ± SD remifentanil (3.96 ± 1.95 vs. 4.42 ± 2.04 ng ml-1; P = 0.0024) and propofol (2.78 ± 1.36 vs. 3.06 ± 1.29 μg ml-1; P = 0.0046) TCI effect site concentrations were lower in the dexmedetomidine group at 30 min postincision and remained lower throughout surgery. When remifentanil (0.133 ± 0.085 vs. 0.198 ± 0.086 μg kg-1 min-1; P = 0.0074) and propofol (5.7 ± 2.72 vs. 7.4 ± 2.80 mg kg-1 h-1; P = 0.0228) requirements are represented as infusion rates, this effect became statistically significant at 2 h postincision.
CONCLUSION
In ASA 1 and 2 patients receiving Nociception Level Index-guided antinociception, dexmedetomidine decreases intra-operative remifentanil requirements. Combined frontal electroencephalogram and Nociception Level Index monitoring can measure dexmedetomidine's hypnotic and opioid-sparing effects during remifentanil-propofol target-controlled infusion anaesthesia.
TRIAL REGISTRATIONS
Clinicaltrials.gov: NCT03912740, EudraCT: 2018-004512-22.
背景
右美托咪定对 Medasense（以色列）痛觉水平指数指导的镇痛作用（Nociception Level Index-guided，NLI）降低术中阿片类药物需求的影响尚未被研究过。
目的
我们旨在确定小剂量右美托咪定是否会降低 NLI 指导镇痛期间瑞芬太尼的需求，而不会增加与右美托咪定相关的并发症。
设计
双盲随机对照试验。
地点
比利时布鲁塞尔的两家大学教学医院。
患者
美国麻醉医师协会（ASA）1 级和 2 级患者（n = 58），在异丙酚-瑞芬太尼靶控输注麻醉下接受颌面或颈面手术。
干预
在诱导前立即输注右美托咪定 30 分钟，输注速率为 1.2μg/kg-1/h-1，然后降至 0.6μg/kg-1/h-1，直至手术结束前 30 分钟。NLI 和额部脑电图分别指导瑞芬太尼和异丙酚的输注。
主要结局
主要结局是瑞芬太尼的需求。其他结局包括异丙酚的需求、心血管状态和术后结局。
结果
术后 30 分钟，右美托咪定组的瑞芬太尼（3.96 ± 1.95 比 4.42 ± 2.04 ng/ml；P = 0.0024）和异丙酚（2.78 ± 1.36 比 3.06 ± 1.29 μg/ml；P = 0.0046）效应部位浓度较低，并且在整个手术过程中一直保持较低水平。当瑞芬太尼（0.133 ± 0.085 比 0.198 ± 0.086 μg/kg-1/min-1；P = 0.0074）和异丙酚（5.7 ± 2.72 比 7.4 ± 2.80 mg/kg-1/h-1；P = 0.0228）的需求以输注率表示时，这种效应在术后 2 小时变得具有统计学意义。
结论
在接受 NLI 指导镇痛的 ASA 1 级和 2 级患者中，右美托咪定可降低术中瑞芬太尼的需求。结合额部脑电图和 NLI 监测，可以测量右美托咪定在瑞芬太尼-异丙酚靶控输注麻醉中对催眠和阿片类药物的节省作用。
试验注册
Clinicaltrials.gov：NCT03912740，EudraCT：2018-004512-22。
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