Department of Anesthesiology and Pain medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
Department of Anesthesiology and Pain medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea; Department of Infection and Immunology, Konkuk University School of Medicine, Seoul, Republic of Korea; Department of Medicine, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, Seoul, Republic of Korea.
J Clin Anesth. 2023 Nov;90:111232. doi: 10.1016/j.jclinane.2023.111232. Epub 2023 Aug 24.
Administering a 5-hydroxytryptamine-3 receptor (5-HT3) at anesthesia induction may aid in achieving hemodynamic stability during general anesthesia induced using opioids. Therefore, we aimed to evaluate the effect of ramosetron, a 5-HT3 antagonist, administered on hypotension at the induction of total intravenous anesthesia (TIVA) with propofol and remifentanil. Additionally, we aimed to compare the impact of ramosetron administration at anesthesia induction versus that at the end of the surgery on postoperative nausea and vomiting (PONV).
Patients were randomly allocated to the Induction group (administration of ramosetron [0.3 mg/5 ml] at anesthesia induction and normal saline [5 ml] at the end of the surgery) or End group (administration of normal saline [5 ml] at anesthesia induction and ramosetron [0.3 mg/5 ml] at the end of the surgery). Hemodynamic status, PONV, and postoperative pain were assessed.
Operating room, post-anesthetic care unit, and general ward.
In total, 176 non-smoking patients without any past medical history undergoing laparoscopic gynecological surgeries under TIVA were included in the study.
Blood pressure (BP), heart rate, PONV, visual analog scale (VAS).
The Induction group exhibited significantly higher BP at anesthesia induction and required significantly lower doses of phenylephrine and ephedrine during anesthesia than the End group had. However, PONV and postoperative pain were similar between the two groups.
Administering ramosetron at anesthesia induction resulted in significantly better hemodynamic stability with significantly lesser requirement of phenylephrine and ephedrine than administering at the end of the surgery did. Therefore, we recommend ramosetron administration at anesthesia induction rather than at the end of the surgery to prevent PONV and the decrease in the mean BP during TIVA with propofol and remifentanil.
在使用阿片类药物诱导全身麻醉时，在麻醉诱导期给予 5-羟色胺 3 受体（5-HT3）拮抗剂可能有助于实现血流动力学稳定。因此，我们旨在评估雷莫司琼（一种 5-HT3 拮抗剂）在丙泊酚和瑞芬太尼全静脉麻醉（TIVA）诱导期间低血压的影响，并比较麻醉诱导时和手术结束时给予雷莫司琼对术后恶心和呕吐（PONV）的影响。
患者被随机分配到诱导组（麻醉诱导时给予雷莫司琼[0.3mg/5ml]，手术结束时给予生理盐水[5ml]）或结束组（麻醉诱导时给予生理盐水[5ml]，手术结束时给予雷莫司琼[0.3mg/5ml]）。评估血流动力学状态、PONV 和术后疼痛。
手术室、麻醉后护理单元和普通病房。
共纳入 176 例无吸烟史且无既往病史的腹腔镜妇科手术患者，接受 TIVA。
血压（BP）、心率、PONV、视觉模拟评分（VAS）。
诱导组在麻醉诱导时的血压明显升高，在麻醉期间需要的苯肾上腺素和麻黄碱剂量明显低于结束组。然而，两组的 PONV 和术后疼痛相似。
与手术结束时相比，麻醉诱导时给予雷莫司琼可显著改善血流动力学稳定性，显著减少苯肾上腺素和麻黄碱的需要量。因此，我们建议在麻醉诱导时给予雷莫司琼，而不是在手术结束时给予雷莫司琼，以预防 TIVA 期间丙泊酚和瑞芬太尼引起的 PONV 和平均血压下降。
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