Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230036, China.
BMC Anesthesiol. 2022 Jun 24;22(1):197. doi: 10.1186/s12871-022-01735-0.
Laryngeal mask airways have been widely used in clinical practice. The aim of this study was to investigate whether the remifentanil requirement for facilitation of i-gel insertion in Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS) surgery was different from that in non-PD (NPD) patients undergoing intracranial surgery.
An up-and-down sequential allocation trial.
Male patients aged between 40 and 64 years old were enrolled. The first patient in each group (PD and NPD) group received an effect-site concentration (Ce) of remifentanil (Minto pharmacokinetic model) of 4.0 ng.ml during a target-controlled infusion (TCI) of 3.5 μg.ml propofol (Marsh pharmacokinetic model). The next dose of remifentanil was determined by the response of the previous patient. The Ce of remifentanil required for i-gel insertion in 50% of patients (EC) was estimated by the modified Dixon's up-and-down method and by probit analysis.
The PD group included 24 patients and the NPD group included 23. The EC of remifentanil for i-gel insertion during a TCI of 3.5 μg.ml propofol estimated by the modified Dixon's up-and-down method in PD patients (2.38 ± 0.65 ng.ml) was significantly lower than in NPD patients (3.21 ± 0.49 ng.ml) (P = 0.03). From the probit analysis, the EC and EC (effective Ce in 95% of patients) of remifentanil were 1.95 (95% CI 1.52-2.36) ng.ml and 3.12 (95% CI 2.53-5.84) ng.ml in PD patients and 2.85 (95% CI 2.26-3.41) ng.ml and 4.57 (95% CI 3.72-8.54) ng.ml in NPD patients, respectively.
The remifentanil requirement for successful i-gel insertion is reduced in male PD patients undergoing DBS implantation during propofol TCI induction. Clinicians should closely monitor the remifentanil requirement in patients with PD.
Registered at http://www.chictr.org.cn ( ChiCTR1900021760 ).
喉罩气道已广泛应用于临床实践。本研究旨在探讨帕金森病（PD）患者在接受深部脑刺激（DBS）手术时，瑞芬太尼用于辅助 i-gel 插入的需要量是否与非帕金森病（NPD）患者接受颅内手术时不同。
上下序贯分配试验。
纳入年龄在 40 岁至 64 岁之间的男性患者。每组（PD 和 NPD）的第一位患者接受靶控输注（TCI） 3.5μg.ml 丙泊酚时（Marsh 药代动力学模型）的瑞芬太尼（Minto 药代动力学模型）效应部位浓度（Ce）为 4.0ng.ml。根据前一位患者的反应确定下一个瑞芬太尼剂量。通过改良 Dixon 上下法和概率分析估计 i-gel 插入 50%患者所需的瑞芬太尼 Ce（EC）。
PD 组纳入 24 例，NPD 组纳入 23 例。PD 患者 TCI 3.5μg.ml 丙泊酚时，改良 Dixon 上下法估计的 i-gel 插入瑞芬太尼 EC（2.38±0.65ng.ml）显著低于 NPD 患者（3.21±0.49ng.ml）（P=0.03）。从概率分析来看，PD 患者的 EC 和 EC（95%置信区间）（95%置信区间内 95%的患者的有效 Ce）分别为 1.95（95%置信区间 1.52-2.36）ng.ml 和 3.12（95%置信区间 2.53-5.84）ng.ml，NPD 患者分别为 2.85（95%置信区间 2.26-3.41）ng.ml 和 4.57（95%置信区间 3.72-8.54）ng.ml。
在丙泊酚 TCI 诱导下接受 DBS 植入的男性 PD 患者，成功插入 i-gel 所需的瑞芬太尼剂量减少。临床医生应密切监测 PD 患者的瑞芬太尼需求。
在中国临床试验注册中心注册（ChiCTR1900021760）。
