瑞芬太尼在帕金森病男性患者行脑深部刺激器植入术中的需求降低：一项上下序贯分配试验。
Remifentanil requirement for i-gel insertion is reduced in male patients with Parkinson's disease undergoing deep brain stimulator implantation: an up-and-down sequential allocation trial.
机构信息
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.
出版信息
BMC Anesthesiol. 2022 Jun 24;22(1):197. doi: 10.1186/s12871-022-01735-0.
BACKGROUND
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.
STUDY DESIGN
An up-and-down sequential allocation trial.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
TRIAL REGISTRATION
Registered at http://www.chictr.org.cn ( ChiCTR1900021760 ).
背景
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。
研究设计
上下序贯分配试验。
方法
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）。
结果
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。
结论
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。
试验注册
在中国临床试验注册中心注册（ChiCTR1900021760）。
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