Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China.
Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA.
Clin Interv Aging. 2021 Jan 15;16:129-137. doi: 10.2147/CIA.S291656. eCollection 2021.
An increasing number of patients with Parkinson's disease (PD) will have surgery under general anesthesia. A previous study demonstrated that propofol requirement for inducing unconsciousness in PD patients was lower than that in non-PD (NPD) patients. However, the requirement of inhaled anesthetics in PD patients has not been clarified. The aim of this study was to investigate the minimum alveolar concentration-awake (MAC) of sevoflurane in patients with PD compared to NPD patients.
The current study is an up-and-down sequential allocation trial. The initial end-tidal concentration of sevoflurane (CETsevo) was estimated by the response of the previous patient to verbal command using the Dixon's up-and-down method. The first patient in each group received CETsevo at 1%, and the step size between patients was 0.2%.
Forty-one patients including 20 PD patients and 21 NPD patients were enrolled. Patients' characteristics and arterial blood gas parameters (except blood sodium) were comparable between two groups. The MAC of sevoflurane estimated by the Dixon's up-and-down method in PD patients (0.47% ± 0.08% [Mean ± S.D.]) was significantly lower than that in NDP patients (0.64% ± 0.10%) (=0.003). The estimated difference in means was 0.17% (95% CI, 0.10-0.24%). Probit analysis showed that the MAC of sevoflurane in PD and NPD patients was 0.49% (95% CI, 0.42-0.57%) and 0.67% (95% CI, 0.59-0.76%), respectively. The relative median potency was 0.73 (95% CI, 0.38-0.94).
Patients with PD exhibit a significantly lower MAC of sevoflurane compared with NPD patients. Clinicians should avoid an overdose of sevoflurane in patients with PD.
Registered at ChiCTR1900026956.
越来越多的帕金森病（PD）患者将在全身麻醉下接受手术。先前的一项研究表明，诱导 PD 患者意识丧失所需的异丙酚用量低于非帕金森病（NPD）患者。然而，PD 患者对吸入麻醉剂的需求尚未得到明确。本研究旨在比较 PD 患者与 NPD 患者七氟醚的最低肺泡有效浓度（MAC）。
本研究为上下序贯分配试验。采用 Dixon 上下法，根据前一位患者对口头指令的反应来估计七氟醚的初始呼气末浓度（CETsevo）。每组的第一个患者接受 CETsevo 浓度为 1%，患者之间的步长为 0.2%。
共纳入 41 例患者，包括 20 例 PD 患者和 21 例 NPD 患者。两组患者的特征和动脉血气参数（除血钠外）均无差异。PD 患者（0.47%±0.08%[Mean±S.D.]）七氟醚的 MAC 由 Dixon 上下法估计，明显低于 NDP 患者（0.64%±0.10%）（=0.003）。估计的均值差异为 0.17%（95%可信区间，0.10-0.24%）。概率分析显示，PD 和 NPD 患者的七氟醚 MAC 分别为 0.49%（95%可信区间，0.42-0.57%）和 0.67%（95%可信区间，0.59-0.76%）。相对中值效价为 0.73（95%可信区间，0.38-0.94）。
与 NPD 患者相比，PD 患者的七氟醚 MAC 明显降低。临床医生应避免在 PD 患者中七氟醚过量。
在中国临床试验注册中心注册，注册号 ChiCTR1900026956。
