Department of Otorhinolaryngology, Hanyang University Guri Hospital, Guri-Si, Gyeonggi-Do, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, 249-1, Gyomun-Dong, Guri-Si, Gyeonggi-Do, 471-701, Republic of Korea.
BMC Anesthesiol. 2023 Aug 29;23(1):292. doi: 10.1186/s12871-023-02253-3.
The combination of propofol and remifentanil results in better surgical field conditions during endoscopic sinus surgery than inhalation anesthesia. This study compared surgical field conditions between two groups receiving low or high concentration of remifentanil and hemodynamic variables using non-invasive cardiac monitoring.
Fifty-four patients between ASA I or II, were randomly assigned to either the high-concentration remifentanil group (HR), effect-site concentration of 8 ng/mL or the low-concentration remifentanil group(LR), effect-site concentration of 4 ng/mL. Surgical condition was evaluated using the Boezaart Surgical Field Grading Scale presented by Boezaart. Cardiac output was measured using non-invasive cardiac monitoring (CSN-1901).
In terms of surgical conditions, the HR group showed significantly lower values than the LR group (p = 0.021) at 90 min after the start of surgery. Heart rate was significantly lower in the HR group than the LR group at 30, 60, and 90 min after the start of surgery (30 min; p = 0.005, 60 min; p = 0.002, 90 min; p = 0.001). There was a statistically significant decrease of cardiac output in the HR group compared to the LR group immediately after endotracheal intubation and at 30, 60, and 90 min after the start of surgery (Base; P = 0.222, Intubation; P = 0.016, 30 min; p = 0.014, 60 min; P = 0.012, 90 min; P = 0.008). However, in the case of stroke volume, there was no significant difference between the two groups in all measurements.
When comparing the HR group and the LR group, the surgical condition was improved at 90 min after the start of surgery. MAP was lower in the HR group and this was a result of reduction in cardiac output primarily attributed to the decrease in heart rate rather than a decrease in stroke volume.
Clinical Trial Registry of the Republic of Korea (KCT0006453).
与吸入麻醉相比，丙泊酚和瑞芬太尼的联合使用可在鼻内镜鼻窦手术中提供更好的手术视野条件。本研究通过非侵入性心脏监测比较了接受高或低瑞芬太尼浓度的两组患者的手术视野条件和血流动力学变量。
54 名 ASA I 或 II 级患者随机分为高浓度瑞芬太尼组（HR 组，效应部位浓度 8ng/mL）或低浓度瑞芬太尼组（LR 组，效应部位浓度 4ng/mL）。手术条件采用 Boezaart 手术视野分级量表（Boezaart Surgical Field Grading Scale）进行评估。心输出量使用非侵入性心脏监测仪（CSN-1901）进行测量。
在手术条件方面，与 LR 组相比，HR 组在手术开始后 90 分钟时的评分明显更低（p=0.021）。与 LR 组相比，HR 组在手术开始后 30、60 和 90 分钟时的心率明显更低（30 分钟：p=0.005，60 分钟：p=0.002，90 分钟：p=0.001）。与 LR 组相比，HR 组在气管插管后即刻以及手术开始后 30、60 和 90 分钟时的心脏输出量均有统计学显著下降（基础：P=0.222，插管：P=0.016，30 分钟：p=0.014，60 分钟：P=0.012，90 分钟：P=0.008）。然而，在每搏量方面，两组在所有测量值中均无显著差异。
与 HR 组相比，LR 组在手术开始后 90 分钟时手术条件得到改善。HR 组的 MAP 较低，这是由于心脏输出量减少，主要是由于心率下降，而不是每搏量下降所致。
韩国临床试验注册处（KCT0006453）。
