Department of Anesthesia, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
Department of Anesthesia, The Second Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
J Clin Pharm Ther. 2021 Dec;46(6):1776-1783. doi: 10.1111/jcpt.13524. Epub 2021 Sep 12.
Remifentanil can effectively decrease the sevoflurane concentration to block sympathetic adrenergic response to CO pneumoperitoneum stimulus,and liver dysfunction will significantly reduce the MAC (minimum alveolar concentration for blocking adrenergic response) of sevoflurane. However, the effects of different remifentanil concentrations on the MAC of sevoflurane in patients with liver dysfunction are unclear. The aim of this study was to observe the effects of different remifentanil concentrations by intravenous target-controlled infusion on the MAC of sevoflurane in patients with grade B liver dysfunction under carbon dioxide pneumoperitoneum stimulus.
Seventy-five patients with grade B liver dysfunction undergoing elective laparoscopic surgery were selected, and randomly divided into three groups with remifentanil plasma target concentrations of 0 (group R ), 1 (group R ) and 2 (group R ) ng/ml. Anaesthesia was induced by intravenous injection of propofol 2-3 mg/kg, remifentanil 2 μg/kg and cisatracurium 0.15 mg/kg. All groups were inhaled different concentrations of sevoflurane. The determination of sevoflurane MAC in each group was used a method of sequential-allocation technique, and venous blood samples were taken before and after the creation of carbon dioxide pneumoperitoneum to determine plasma adrenaline and noradrenaline concentrations.
The MAC of sevoflurane in groups R , R and R was 4.83%, 3.00% and 2.10%, respectively. The MAC of sevoflurane was significantly difference among the three groups. When a similar effect of MAC had achieved in each group, no significant differences were found in the changes of plasma adrenaline and noradrenaline concentrations before and after the creation of pneumoperitoneum. What is new and conclusion Target-controlled infusion of different concentrations of remifentanil can reduce sevoflurane MAC during pneumoperitoneum stimulation in patients with liver dysfunction in some degree. However, the changes of plasma adrenaline and noradrenaline concentrations are consistent in the three groups when patient's stress response was inhibited at the same degree.
瑞芬太尼可有效降低七氟醚浓度，以阻断交感神经肾上腺素反应对 CO2 气腹刺激，肝功能障碍会显著降低七氟醚的 MAC（阻断肾上腺素反应的最小肺泡浓度）。然而，不同瑞芬太尼浓度对肝功能障碍患者七氟醚 MAC 的影响尚不清楚。本研究旨在观察不同浓度瑞芬太尼静脉靶控输注对二氧化碳气腹刺激下 B 级肝功能障碍患者七氟醚 MAC 的影响。
选择 75 例 B 级肝功能障碍择期腹腔镜手术患者，随机分为三组，瑞芬太尼血浆靶浓度分别为 0（组 R0）、1（组 R1）和 2（组 R2）ng/ml。麻醉诱导采用静脉注射异丙酚 2-3mg/kg、瑞芬太尼 2μg/kg和顺式阿曲库铵 0.15mg/kg。所有组均吸入不同浓度的七氟醚。采用序贯分配技术确定每组七氟醚 MAC，气腹建立前后分别抽取静脉血样，测定血浆肾上腺素和去甲肾上腺素浓度。
组 R0、组 R1 和组 R2 的七氟醚 MAC 分别为 4.83%、3.00%和 2.10%。三组七氟醚 MAC 有显著差异。当每组达到相似的 MAC 效应时，气腹建立前后血浆肾上腺素和去甲肾上腺素浓度的变化无显著差异。
靶控输注不同浓度的瑞芬太尼可在一定程度上降低肝功能障碍患者气腹刺激时七氟醚的 MAC。然而，当抑制患者应激反应的程度相同时，三组患者的血浆肾上腺素和去甲肾上腺素浓度变化一致。
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