Nephrology Department, Peking University International Hospital, Beijing, P.R. China.
Anesthesiology Department, Peking University International Hospital, Beijing, P.R. China.
Ren Fail. 2023;45(2):2278301. doi: 10.1080/0886022X.2023.2278301. Epub 2023 Nov 23.
Conscious sedation anesthesia (CSA) is an anesthetic method during peritoneal dialysis catheter implantation. However, lack of optimal CSA strategies for patients with end-stage renal disease (ESRD). This study aimed to evaluate the analgesic effects and safety of CSA using different doses of remifentanil combined with dexmedetomidine during peritoneal dialysis catheter insertion.
Patients who underwent peritoneal dialysis (PD) catheter placement open surgical incision were retrospectively analyzed and divided into three groups based on the tertile dose of remifentanil. The bispectral index (BIS) was used to monitor the depth of anesthesia. Data regarding clinical findings, the effects of anesthesia, and the incidence of drug-related adverse effects were collected.
In total, 102 patients completed the surgery successfully and safely. The dose of remifentanil was 0.02-0.07 μg/kg/min, 0.08-0.13 μg/kg/min, and 0.14-0.20 μg/kg/min in Groups A, B, and C, respectively. Only seven patients reported mild pain during the surgery. No significant differences were observed among the numeric rating scale scores of the three groups ( > 0.05). Intraoperative hemodynamics were stable. The incidence of respiratory depression was 8.3%, 20.0%, and 41.9% in Groups A, B, and C, respectively ( < 0.01). The incidence of gastrointestinal symptoms in Group C (51.6%) was higher than that in Groups A and B ( < 0.05).
Low-dose remifentanil (0.02-0.07 μg/kg/min) combined with dexmedetomidine achieved satisfactory anesthetic effects with fewer adverse drug reactions during PD catheter implantation, indicating its potential for use in patients undergoing PD catheter placement.
清醒镇静麻醉（CSA）是腹膜透析导管植入术期间的一种麻醉方法。然而，终末期肾病（ESRD）患者缺乏最佳的 CSA 策略。本研究旨在评估不同剂量瑞芬太尼联合右美托咪定用于腹膜透析导管置入术时的镇痛效果和安全性。
回顾性分析接受腹膜透析（PD）导管置管术的患者，采用瑞芬太尼三分位剂量分组，脑电双频指数（BIS）监测麻醉深度。记录临床观察指标、麻醉效果及药物相关不良反应的发生情况。
共 102 例患者顺利、安全完成手术。瑞芬太尼剂量分别为 A 组 0.02-0.07μg/kg/min、B 组 0.08-0.13μg/kg/min、C 组 0.14-0.20μg/kg/min。术中仅 7 例患者诉轻度疼痛。三组患者数字评分量表评分无显著差异（ > 0.05）。术中血流动力学稳定。呼吸抑制发生率分别为 A 组 8.3%、B 组 20.0%、C 组 41.9%（ < 0.01）。C 组（51.6%）胃肠道症状发生率高于 A 组和 B 组（ < 0.05）。
低剂量瑞芬太尼（0.02-0.07μg/kg/min）联合右美托咪定用于 PD 导管植入术可获得满意的麻醉效果，且药物不良反应发生率较低，有望用于 PD 导管置管术患者。
