Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, Zhejiang Chinese Medical University), Hangzhou, People's Republic of China.
Department of Anesthesiology, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medicine College), Hangzhou, People's Republic of China.
Drug Des Devel Ther. 2024 Aug 22;18:3729-3737. doi: 10.2147/DDDT.S473662. eCollection 2024.
This study aimed to investigate the influence of fentanyl on the effective dose of remimazolam-induced sedation in elderly female patients undergoing general anesthesia.
Sixty female patients aged 65-80 years undergoing selective general anesthesia were randomized into two groups: Group R+F received an initial dose of remimazolam (7.5 mg) with fentanyl (1 μg/kg), while Group R received remimazolam alone. Dosing adjustments (±2.5 mg) were made based on the response of the preceding patient using the up-and-down allocation technique. The ED50 and ED95 were calculated using a sequential formula and probit regression. Probit regression was also used to assess the relative potency of remimazolam between groups. Sedation levels were evaluated using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale.
The ED50 for remimazolam was significantly lower in Group R+F compared to Group R (= 0.007). Probit regression estimated the ED50 and ED95 values for Group R+F at 4.878 mg (95% CI, 3.845-5.859) and 8.184 mg (95% CI, 6.636-13.546), respectively. In contrast, Group R demonstrated ED50 and ED95 values of 6.733 mg (95% CI, 5.533-8.068) and 11.298 mg (95% CI, 9.101-19.617), respectively.
This study provides compelling evidence that the administration of 1 μg/kg of fentanyl significantly reduces the required sedative dose of remimazolam by approximately 30% during induction in elderly patients. Importantly, the concomitant use of 1 μg/kg of fentanyl does not increase the risk of adverse effects such as hypotension, respiratory depression.
本研究旨在探讨芬太尼对老年女性全麻患者咪达唑仑镇静有效剂量的影响。
选择年龄 65-80 岁择期全麻的女性患者 60 例，随机分为两组：R+F 组给予咪达唑仑（7.5mg）初始剂量加芬太尼（1μg/kg），R 组给予咪达唑仑。采用上下分配法，根据前一个患者的反应进行剂量调整（±2.5mg）。采用序贯公式和概率回归法计算 ED50 和 ED95。概率回归法还用于评估两组之间咪达唑仑的相对效价。采用改良警觉/镇静评分（MOAA/S）评估镇静水平。
R+F 组咪达唑仑 ED50 明显低于 R 组（P=0.007）。概率回归法估计 R+F 组的 ED50 和 ED95 值分别为 4.878mg（95%CI：3.845-5.859）和 8.184mg（95%CI：6.636-13.546）。相比之下，R 组的 ED50 和 ED95 值分别为 6.733mg（95%CI：5.533-8.068）和 11.298mg（95%CI：9.101-19.617）。
本研究有力地证明，在老年患者诱导时给予 1μg/kg 芬太尼可显著降低咪达唑仑镇静所需的诱导剂量，约减少 30%。重要的是，同时使用 1μg/kg 芬太尼不会增加低血压、呼吸抑制等不良反应的风险。
