Hogue C W, Bowdle T A, O'Leary C, Duncalf D, Miguel R, Pitts M, Streisand J, Kirvassilis G, Jamerson B, McNeal S, Batenhorst R
Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Anesth Analg. 1996 Aug;83(2):279-85. doi: 10.1097/00000539-199608000-00014.
Remifentanil is a mu-opioid receptor agonist with a context sensitive half-time of 3 min and an elimination half-life < or = 10 min. This study sought to evaluate the efficacy of remifentanil and propofol total intravenous anesthesia (TIVA) in 161 patients undergoing inpatient surgery. Remifentanil 1 microgram/kg was given intravenously (i.v.) followed by one of two randomized infusion rates: small dose (0.5 micrograms.kg-1.min-1) or large dose (1 microgram.kg-1.min-1). Propofol (0.5-1.0 mg/kg i.v. bolus and 75 micrograms.kg-1.min-1 infusion) and vecuronium were also given. Remifentanil infusions were decreased by 50% after tracheal intubation. End points included responses (hypertension, tachycardia, and somatic responses) to tracheal intubation and surgery. More patients in the small-dose than in the large-dose group responded to tracheal intubation with hypertension and/or tachycardia (25% vs 6%; P = 0.003) but there were no other differences between groups in intraoperative responses. Recovery from anesthesia was within 3-7 min in both groups. The most frequent adverse events were hypotension (systolic blood pressure [BP] < 80 mm Hg or mean BP < 60 mm Hg) during anesthesia induction (10% small-dose versus 15% large-dose group; P = not significant [NS]) and hypotension (27% small-dose versus 30% large-dose group; P = NS), and bradycardia (7% small-dose versus 19% large-dose group; P = NS) during maintenance. In conclusion, when combined with propofol 75 micrograms.kg-1.min-1, remifentanil 1 microgram/kg i.v. as a bolus followed by an infusion of 1.0 microgram.kg-1.min-1 effectively controls responses to tracheal intubation. After tracheal intubation, remifentanil 0.25-4.0 micrograms.kg-1.min-1 effectively controlled intraoperative responses while allowing for rapid emergence from anesthesia.
瑞芬太尼是一种μ阿片受体激动剂，其时效半衰期为3分钟，消除半衰期≤10分钟。本研究旨在评估瑞芬太尼和丙泊酚全凭静脉麻醉（TIVA）用于161例住院手术患者的疗效。静脉注射1微克/千克瑞芬太尼，随后采用两种随机输注速率之一：小剂量（0.5微克·千克⁻¹·分钟⁻¹）或大剂量（1微克·千克⁻¹·分钟⁻¹）。同时给予丙泊酚（0.5 - 1.0毫克/千克静脉推注和75微克·千克⁻¹·分钟⁻¹输注）和维库溴铵。气管插管后瑞芬太尼输注量减少50%。终点指标包括气管插管和手术时的反应（高血压、心动过速和躯体反应）。小剂量组对气管插管出现高血压和/或心动过速反应的患者比大剂量组更多（25%对6%；P = 0.003），但两组术中反应的其他方面无差异。两组麻醉恢复均在3 - 7分钟内。最常见的不良事件是麻醉诱导期间的低血压（收缩压[BP]<80毫米汞柱或平均血压<60毫米汞柱）（小剂量组10%对大剂量组15%；P = 无显著差异[NS]）以及维持期间的低血压（小剂量组27%对大剂量组30%；P = NS）和心动过缓（小剂量组7%对大剂量组19%；P = NS）。总之，当与75微克·千克⁻¹·分钟⁻¹丙泊酚合用时，静脉注射1微克/千克瑞芬太尼推注后以1.0微克·千克⁻¹·分钟⁻¹输注可有效控制气管插管反应。气管插管后，0.25 - 4.0微克·千克⁻¹·分钟⁻¹的瑞芬太尼可有效控制术中反应，同时允许快速苏醒。
