Grundmann U, Uth M, Eichner A, Wilhelm W, Larsen R
Department of Anesthesiology and Critical Care Medicine, University of Saarland, Homburg/Saar, Germany.
Acta Anaesthesiol Scand. 1998 Aug;42(7):845-50. doi: 10.1111/j.1399-6576.1998.tb05332.x.
Remifentanil is a new rapid-acting and ultra-short acting mu-opioid receptor agonist with few reports from use in children. Therefore, we compared a propofol-remifentanil-anaesthesia (TIVA) with a desflurane-N2O-anaesthesia (DN) with particular regard to the recovery of characteristics in children.
50 children (4-11 yr) scheduled for ENT surgery were randomly assigned to receive TIVA (n = 25) or DN (N = 25). After standardised i.v. induction of anaesthesia in both groups with remifentanil, propofol and cisatracurium, TIVA was maintained with infusion of propofol and remifentanil. Ventilation was with oxygen in air. DN was maintained with desflurane in 50% N20. The administration of volatile and intravenous anaesthetics was adjusted to maintain a surgical plane of anaesthesia. At the end of surgery all anaesthetics were terminated without tapering and early emergence and recovery were assessed. In addition, side effects were noted.
Both anaesthesia methods resulted in stable haemodynamics but significantly higher heart rate with desflurane. Recovery did not differ between the groups except for delayed spontaneous respiration after TIVA. Spontaneous ventilation occurred after 11 +/- 03.7 min versus 7.2 +/- 2.8 min (mean +/- SD, TIVA versus DN), extubation after 11 +/- 3.7 min versus 9.4 +/- 2.9 min, eye opening after 11 +/- 3.9 min versus 14 +/- 7.6 min and Aldrete score > or = 9 after 17 +/- 6.8 min versus 17 +/- 7.5 min. Postoperatively, there was a significant higher incidence of agitation in the DN group (80% vs. 44%) but a low incidence (< 10%) of nausea and vomiting in both groups.
In children, TIVA with remifentanil and propofol is a well-tolerated anaesthesia method, with a lower peroperative heart rate and less postoperative agitation compared with a desflurane-N2O based anaesthesia.
瑞芬太尼是一种新型速效和超短效μ阿片受体激动剂，在儿童中的使用报道较少。因此，我们比较了丙泊酚-瑞芬太尼麻醉（全凭静脉麻醉，TIVA）和地氟醚-N₂O麻醉（DN），特别关注儿童的恢复特征。
50例计划行耳鼻喉手术的儿童（4 - 11岁）被随机分配接受TIVA（n = 25）或DN（n = 25）。两组均用瑞芬太尼、丙泊酚和顺式阿曲库铵进行标准化静脉麻醉诱导后，TIVA组通过输注丙泊酚和瑞芬太尼维持麻醉。通气采用空气和氧气混合。DN组用50% N₂O和地氟醚维持麻醉。调整挥发性和静脉麻醉药的给药以维持手术麻醉平面。手术结束时，所有麻醉药均不减量停药，并评估早期苏醒和恢复情况。此外，记录副作用。
两种麻醉方法均导致血流动力学稳定，但地氟醚组心率显著更高。除TIVA后自主呼吸延迟外，两组恢复情况无差异。自主通气出现时间分别为11±3.7分钟（TIVA组）和7.2±2.8分钟（DN组），拔管时间分别为11±3.7分钟和9.4±2.9分钟，睁眼时间分别为11±3.9分钟和14±7.6分钟，Aldrete评分≥9分的时间分别为17±6.8分钟和17±7.5分钟。术后，DN组躁动发生率显著更高（80%对44%），但两组恶心呕吐发生率均较低（<10%）。
在儿童中，瑞芬太尼和丙泊酚的TIVA是一种耐受性良好的麻醉方法，与基于地氟醚-N₂O的麻醉相比，术中心率更低，术后躁动更少。
