Smith I, Avramov M N, White P F
Department of Anesthesiology and Pain Management, University of Texas South-western Medical Center at Dallas 75235-9068, USA.
J Clin Anesth. 1997 Mar;9(2):148-54. doi: 10.1016/S0952-8180(96)00240-1.
To compare remifentanil, an esterase-metabolized opioid, to a standard propofol-based sedation technique for monitored anesthesia care (MAC).
Non-randomized, open label.
University hospital.
44 healthy female outpatients undergoing breast biopsy procedures under local anesthesia.
All patients received intravenous (IV) midazolam 2 mg, followed by a continuous infusion of either propofol 75 micrograms/kg/min, or remifentanil 0.1 microgram/kg/min, which was subsequently titrated to maintain optimal patient comfort without respiratory depression. Surgical-related pain was treated by injecting additional local anesthetic solution and "rescue" boluses of fentanyl 25 micrograms IV.
Sedation, pain, and discomfort were monitored using standardized rating scales at 1 to 5 minute intervals. Recovery times were measured from the end of the study drug infusions. Propofol resulted in significantly higher median sedation scores compared with remifentanil, with 73% of patients requiring a decrease in the propofol infusion rate because of "excessive" sedation. Local anesthetic requirements, pain, and discomfort scores during surgery were similar in both groups. Remifentanil resulted in greater respiratory depression compared with propofol, with decreases in the remifentanil infusion rate required by 41% of patients because of a slow respiratory rate (< 8 bpm) and/or oxygen desaturation measured by pulse oximetry (SpO2 < 90%). Median times to ambulation and to being judged "fit for discharge" were significantly shorter following propofol (40 and 47 minutes, respectively) compared with remifentanil (52 and 58 minutes, respectively).
Remifentanil provided comparable intraoperative conditions and patient comfort at a lower sedation level compared with propofol. However, remifentanil was associated with greater respiratory depression and a longer time to home readiness.
比较瑞芬太尼（一种经酯酶代谢的阿片类药物）与基于丙泊酚的标准镇静技术用于监护麻醉（MAC）的效果。
非随机、开放标签。
大学医院。
44名接受局部麻醉下乳腺活检手术的健康女性门诊患者。
所有患者静脉注射咪达唑仑2毫克，随后持续输注丙泊酚75微克/千克/分钟或瑞芬太尼0.1微克/千克/分钟，随后进行滴定以维持患者最佳舒适度且无呼吸抑制。手术相关疼痛通过注射额外的局部麻醉溶液和静脉注射25微克芬太尼“解救”推注进行治疗。
每隔1至5分钟使用标准化评分量表监测镇静、疼痛和不适情况。从研究药物输注结束时开始测量恢复时间。与瑞芬太尼相比，丙泊酚导致的中位镇静评分显著更高，73%的患者因“过度”镇静需要降低丙泊酚输注速率。两组手术期间局部麻醉需求、疼痛和不适评分相似。与丙泊酚相比，瑞芬太尼导致的呼吸抑制更严重，41%的患者因呼吸频率减慢（<8次/分钟）和/或脉搏血氧饱和度测量的氧饱和度下降（SpO2<90%）需要降低瑞芬太尼输注速率。与瑞芬太尼（分别为52分钟和58分钟）相比，丙泊酚输注后中位下床活动时间和被判定“适合出院”的时间显著更短（分别为40分钟和47分钟）。
与丙泊酚相比，瑞芬太尼在较低镇静水平下提供了相当的术中条件和患者舒适度。然而，瑞芬太尼与更严重的呼吸抑制和更长时间至准备回家相关。
