Ma Jinben, Wang Yu, Liu Zhifei, Han Shaoxian
Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Jingwuwei 7th Road, Jinan, 250021, China.
Department of Surgery, Shandong Public Health Clinical Center, Shandong University, No.11, Lieshishan East Road, Jinan, 250021, China.
BMC Anesthesiol. 2025 May 15;25(1):244. doi: 10.1186/s12871-025-03104-z.
Laparoscopic inguinal hernia repair (LIHR) has the characteristics of a clear surgical field and short operation time, but it has high requirements for anesthesia. We investigated the impacts of different doses of remifentanil combined with sevoflurane anesthesia on postoperative analgesia and hemodynamics of pediatric LIHR.
This randomized, double-blind and controlled study included 310 pediatric patients accepting LIHR. Excluding those failed to meet the inclusion or met the exclusion criteria, 280 patients were enrolled and randomized into the control group (sevoflurane) and the low-dose remifentanil & sevoflurane (LRS), medium-dose remifentanil & sevoflurane (MRS) and high-dose remifentanil & sevoflurane (HRS) groups (0.10, 0.20 and 0.25 µg/kg). The Behavior Pain Scale (BPS) (main observation index), Ramsay Sedation Scale (RSS), and Paediatric Anaesthesia Emergence Delirium (PAED) scores were evaluated at 1 h (T4), 3 h (T5), 6 h (T6), 8 h (T7) and 12 h (T8) postoperatively. The dynamic process of BPS, RSS and PAED scores over time was evaluated by analyzing the changes in the area under the curve (AUC) of each score during T4-T8. The changes in mean arterial pressure (MAP), heart rate (HR) and oxygen saturation (SpO) before the start of anesthesia (T0), 10-min after the start of surgery (T1), at the time of extubation (T2) and 30-min post-surgery (T3) and postoperative adverse reaction incidence were recorded.
Remifentanil & sevoflurane reduced postoperative BPS and PAED scores and increased RSS score in pediatric patients during T4-T8. The AUC and AUC in the LRS, MRS and HRS groups decreased as the remifentanil dose increased, and the AUC increased as the remifentanil dose rose. During T0-T3, MAP, HR and SpO fluctuated greatly in the control group, but maintained good stability in the LRS, MRS and HRS groups, and the fluctuation in the HRS group was smaller. The HRS group had a lower adverse reaction incidence than the control and LRS groups.
Remifentanil & sevoflurane may have better effects on postoperative pain, sedation and agitation, and may be more conducive to stabilizing hemodynamics. Especially, 0.25 mg/kg remifentanil & sevoflurane have the best anesthetic effect and a low adverse reaction incidence.
腹腔镜腹股沟疝修补术（LIHR）具有手术视野清晰、手术时间短的特点，但对麻醉要求较高。我们研究了不同剂量瑞芬太尼联合七氟醚麻醉对小儿LIHR术后镇痛和血流动力学的影响。
本随机、双盲、对照研究纳入310例接受LIHR的小儿患者。排除不符合纳入标准或符合排除标准的患者后，280例患者入组并随机分为对照组（七氟醚）和低剂量瑞芬太尼&七氟醚（LRS）、中剂量瑞芬太尼&七氟醚（MRS）和高剂量瑞芬太尼&七氟醚（HRS）组（0.10、0.20和0.25μg/kg）。分别于术后1小时（T4）、3小时（T5）、6小时（T6）、8小时（T7）和12小时（T8）评估行为疼痛量表（BPS）（主要观察指标）、 Ramsay镇静量表（RSS）和小儿麻醉苏醒期谵妄（PAED）评分。通过分析T4-T8期间各评分曲线下面积（AUC）的变化，评估BPS、RSS和PAED评分随时间的动态变化过程。记录麻醉开始前（T0）、手术开始后10分钟（T1）、拔管时（T2）、术后30分钟（T3）的平均动脉压（MAP）、心率（HR）和血氧饱和度（SpO）变化以及术后不良反应发生率。
瑞芬太尼&七氟醚降低了小儿患者T4-T8期间的术后BPS和PAED评分，并提高了RSS评分。LRS、MRS和HRS组的AUC和AUC随瑞芬太尼剂量增加而降低，而AUC随瑞芬太尼剂量升高而增加。在T0-T3期间，对照组的MAP、HR和SpO波动较大，但LRS、MRS和HRS组保持良好稳定性，且HRS组波动更小。HRS组的不良反应发生率低于对照组和LRS组。
瑞芬太尼&七氟醚可能对术后疼痛、镇静和躁动有更好的效果，且可能更有利于稳定血流动力学。特别是，0.25mg/kg瑞芬太尼&七氟醚具有最佳麻醉效果和较低的不良反应发生率。
