Department of Anaesthesiology, University Medical Centre Groningen, Groningen, Netherlands.
Department of Anaesthesia and Reanimation, AZ Sint-Jan Brugge AV, Bruges, Belgium.
J Clin Monit Comput. 2024 Dec;38(6):1347-1355. doi: 10.1007/s10877-024-01195-6. Epub 2024 Jul 20.
Post-induction hypotension (MAP < 65 mmHg) occurs frequently and is usually caused by the cardiovascular adverse effects of the anaesthetic induction drugs used. We hypothesize that a clinically significant difference in the incidence and severity of hypotension will be found when different doses of propofol and remifentanil are used for induction of anaesthesia.
This is a secondary analysis of a randomised controlled trial wherein four groups (A-D) of patients received one out of four different combinations of propofol and remifentanil, titrated to a predicted equipotency in probability of tolerance to laryngoscopy (PTOL) according to the Bouillon interaction model. In group A, a high dose of propofol and a low dose of remifentanil was administered, and across the groups this ratio was gradually changed until it was reversed in group D. Mean and systolic arterial blood pressure (MAP, SAP) were compared at four time points (T, T, T, T) within and between groups Heart rate, bispectral index (BIS) and the incidence of hypotension were compared.
Data from 76 patients was used. At T a statistically significant lower MAP and SAP was found in group A versus D (p = 0.011 and p = 0.002). A significant higher heart rate was found at T and T between groups A and B when compared to groups C and D (p = < 0.001 and p = 0.002). A significant difference in BIS value was found over all groups at T and T (both p < 0.001). All other outcomes did not differ significantly between groups.
Induction of anaesthesia with different predicted equipotent combinations of propofol and remifentanil did result in statistically different but clinically irrelevant differences in haemodynamic endpoints during induction of anaesthesia. Our study could not identify preferable drug combinations that decrease the risk for hypotension after induction, although they all yield a similar predicted PTOL.
诱导后低血压（MAP<65mmHg）经常发生，通常是由麻醉诱导药物的心血管不良反应引起的。我们假设，当使用不同剂量的异丙酚和瑞芬太尼进行麻醉诱导时，会发现低血压的发生率和严重程度存在显著差异。
这是一项随机对照试验的二次分析，其中四组（A-D）患者接受了异丙酚和瑞芬太尼的四种不同组合之一，根据 Bouillon 相互作用模型，根据预测的对喉镜耐受概率（PTOL）进行滴定，以达到等效剂量。在组 A 中，给予高剂量的异丙酚和低剂量的瑞芬太尼，并且在整个组中，逐渐改变这种比例，直到在组 D 中逆转。在组内和组间比较了四个时间点（T、T、T、T）的平均动脉压（MAP、SAP）和收缩压。比较了心率、双频谱指数（BIS）和低血压的发生率。
使用了 76 名患者的数据。在 T 时，与组 D 相比，组 A 的 MAP 和 SAP 明显降低（p=0.011 和 p=0.002）。与组 C 和 D 相比，组 A 和 B 在 T 和 T 时心率明显升高（p<0.001 和 p=0.002）。在所有组中，在 T 和 T 时 BIS 值均有显著差异（均 p<0.001）。所有其他结果在组间无显著差异。
用不同的预测等效组合异丙酚和瑞芬太尼诱导麻醉会导致麻醉诱导期间血流动力学终点的统计学差异，但临床无相关性。我们的研究无法确定可降低诱导后低血压风险的更优药物组合，尽管它们都产生了类似的预测 PTOL。
