Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China.
Division of Urological Surgery, Department of Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China.
Medicine (Baltimore). 2022 Sep 9;101(36):e30466. doi: 10.1097/MD.0000000000030466.
Until now, target-controlled infusion of remifentanil with midazolam for transrectal ultrasound-guided prostate biopsy has not been described. Here, we investigate 2 effect-site concentrations of remifentanil with intermittent bolus midazolam for transrectal ultrasound-guided prostate biopsy under procedural analgesia and sedation.
A prospective, randomized controlled trial including patients who received a transrectal ultrasound-guided prostate biopsy between February 2019 and January 2021 was conducted. Group 1 and Group 2 were respectively administered an initial effect-site concentration of remifentanil of 1.0 ng/mL and 2.0 ng/mL by a target-controlled infusion pump with Minto model. In both groups, maintenance of the effect-site concentration of remifentanil was adjusted upward and downward by 0.5 ng/mL to keep patient comfort with acceptable pain (remaining moveless), and mean arterial pressure and heart rate within baseline levels ± 30%, and using intermittent bolus midazolam to keep the Observer's Assessment of Alertness/Sedation scale between 2 and 4. The primary outcome was to determine which effect-site concentration of remifentanil provide adequate patient comfort with acceptable pain (remaining moveless) during the procedure.
A total of 40 patients in Group 1 and 40 patients in Group 2 were eligible for analysis. Most parameters were insignificantly different between Group 1 and Group 2, except Group 1 having higher peripheral oxygen saturation while probe insertion compared with Group 2. Group 2 patients had less intraoperative movements affecting the procedure (2 vs 18; P < .001), and less total times of target-controlled infusion pump adjustment (0 [0-1] vs 1 [0-3], P < .001) compared with group 1. However, group 1 patients had less apnea with desaturation (peripheral oxygen saturation < 90%; 0 vs 9, P = .002) and less remifentanil consumption (94.9 ± 25.5 μg vs 106.2 ± 21.2 μg, P = .034) compared to Group 2.
In transrectal ultrasound-guided prostate biopsy, target-controlled infusion with remifentanil Minto model target 2.0 ng/mL with 3 to 4 mg midazolam use provided sufficient analgesia and sedation, and appropriate hemodynamic and respiratory conditions.
目前，尚无瑞芬太尼靶控输注联合咪达唑仑用于经直肠超声引导下前列腺活检的相关报道。本研究旨在观察经直肠超声引导下前列腺活检术中应用不同靶浓度瑞芬太尼复合咪达唑仑间断推注镇静镇痛的效果。
前瞻性、随机对照研究纳入 2019 年 2 月至 2021 年 1 月行经直肠超声引导下前列腺活检术的患者。采用瑞芬太尼效应室靶控输注，设定初始效应室浓度，Minto 模型，Ⅰ组为 1.0ng/ml，Ⅱ组为 2.0ng/ml。两组均以 0.5ng/ml 的幅度调整瑞芬太尼效应室浓度，维持患者术中镇痛镇静效果满意（无体动），平均动脉压、心率维持在基础值±30%，间断推注咪达唑仑使患者警觉/镇静评分（OAA/S）维持在 2~4 分。主要结局为比较两组患者不同瑞芬太尼效应室靶浓度下患者术中镇痛镇静效果。
Ⅰ组和Ⅱ组各 40 例患者符合分析标准。Ⅰ组患者在探头置入时外周血氧饱和度高于Ⅱ组（P<0.001），但Ⅱ组患者术中体动影响操作（2 例 vs 18 例；P<0.001）和靶控输注泵调整次数（0[01]次 vs 1[03]次；P<0.001）少于Ⅰ组。然而，Ⅰ组患者呼吸暂停伴低氧血症（外周血氧饱和度<90%）和瑞芬太尼用量（94.9±25.5μg vs 106.2±21.2μg）少于Ⅱ组（P<0.001 和 P=0.034）。
经直肠超声引导下前列腺活检术，瑞芬太尼效应室靶控输注，Ⅱ组设定目标浓度 2.0ng/ml 复合咪达唑仑 3~4mg 可提供充分的镇痛镇静效果，同时具有适当的血流动力学和呼吸状态。
