在麻醉趋势监测下使用或不使用瑞芬太尼的七氟醚在 Supreme 喉罩下剖宫产的半数有效浓度（EC50）和效果比较：一项随机试验。

Comparison of the median effective concentration (EC50) and effect of sevoflurane with or without remifentanil in cesarean section with supreme laryngeal mask under narcotrend monitoring: a randomized trial.

机构信息

Department of Anesthesiology, Quanzhou Women's and Children's Hospital, Quanzhou, China.

出版信息

Ann Palliat Med. 2021 Nov;10(11):11578-11586. doi: 10.21037/apm-21-2664.

DOI:10.21037/apm-21-2664

PMID:34872283

Abstract

BACKGROUND

Remifentanil combined with sevoflurane is a standard protocol for obstetric general anesthesia (GA).

METHODS

In this study, we performed a randomized clinical trial to evaluate whether remifentanil has an effect on the median effective concentration (EC50) of sevoflurane and compare anesthetic outcomes of them in cesarean section with Supreme™ laryngeal mask airway (SLMA) under narcotrend monitoring. Ninety parturients with singleton births undergoing elective cesarean delivery (CD) with initial inhaled 1.0 minimum alveolar concentration (MAC) sevoflurane for anesthesia maintenance were assigned to three groups randomly and evenly: Group A (0.05 µg·kg-1·min-1 remifentanil combined with sevoflurane), Group B (0.1 µg·kg-1·min-1 remifentanil combined with sevoflurane), and Group C (normal saline combined with sevoflurane). Narcotrend was used to monitor the depth of anesthesia during the operation, with the level of anesthesia depth controlled within the D-E stage. The EC50 of sevoflurane was determined by Dixon's sequential method. The Narcotrend index, amount of bleeding, neonatal Apgar score, and corresponding treatment measures in the three groups were recorded.

RESULTS

The results showed that the estimated EC50 of sevoflurane for obstetric GA was 0.80 MAC (95% CI: 0.63-0.95 MAC) in group A, 0.82 MAC (95% CI: 0.63-0.96 MAC) in group B, and 0.80 MAC (95% CI: 0.63-0.95 MAC) in group C. There was no statistically significant difference in the estimated EC50 of sevoflurane, time to wakefulness, Apgar score, amount of intraoperative bleeding, and postoperative bleeding within 24 hours between the three groups (all P>0.05).

CONCLUSIONS

The addition of remifentanil at 0.05-0.1 µg·kg-1·min-1 did not change the EC50 of sevoflurane and anesthetic quality. The concentration of inhaled anesthetics can be minimized with Narcotrend monitoring.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2000034512.

摘要

背景

瑞芬太尼复合七氟醚是产科全身麻醉（GA）的标准方案。

方法

本研究通过随机临床试验评估瑞芬太尼是否会影响七氟醚的半数有效浓度（EC50），并比较在 Supreme™喉罩气道（SLMA）下使用麻醉监护仪进行麻醉监测时，剖宫产术中瑞芬太尼复合七氟醚与七氟醚单独使用的麻醉效果。90 例择期行剖宫产术的单胎产妇，初始吸入 1.0 最低肺泡有效浓度（MAC）七氟醚维持麻醉，随机等分为三组：A 组（0.05μg·kg-1·min-1瑞芬太尼复合七氟醚）、B 组（0.1μg·kg-1·min-1瑞芬太尼复合七氟醚）和 C 组（生理盐水复合七氟醚）。术中采用麻醉监护仪监测麻醉深度，将麻醉深度控制在 D-E 期。采用 Dixon 序贯法确定七氟醚的 EC50。记录三组患者的麻醉监护仪指数、出血量、新生儿 Apgar 评分及相应的处理措施。

结果

结果显示，A 组、B 组和 C 组产科 GA 时瑞芬太尼复合七氟醚的估计 EC50 分别为 0.80 MAC（95%CI：0.63-0.95 MAC）、0.82 MAC（95%CI：0.63-0.96 MAC）和 0.80 MAC（95%CI：0.63-0.95 MAC），三组间瑞芬太尼的估计 EC50、清醒时间、Apgar 评分、术中出血量及术后 24 小时内出血量比较，差异均无统计学意义（均 P＞0.05）。