Lauwers M, Camu F, Breivik H, Hagelberg A, Rosen M, Sneyd R, Horn A, Noronha D, Shaikh S
Department of Anesthesiology, Flemish Free University of Brussels Medical Center, Belgium.
Anesth Analg. 1999 Jan;88(1):134-40. doi: 10.1097/00000539-199901000-00025.
We assessed the sedative potential of continuous infusions of remifentanil with a validated composite alertness scale in 160 patients (ASA physical status I or II) undergoing hip replacement surgery with spinal block (n = 61) or hand surgery using brachial plexus block (n = 93). They were randomized to receive one of the following initial dose regimens in double-blinded fashion: placebo or 0.04, 0.07, or 0.1 microg x kg(-1) x min(-1) remifentanil subsequently titrated to effect. Additional midazolam IV was allowed for adequate sedation as required. The combined analysis of both surgery groups revealed a dose-related increase in achievement of sedation level > or =2 within 15 min of the start of the study drug infusion; all remifentanil dose comparisons with placebo reached significance (P < 0.001). The remifentanil 50% effective dose for a composite sedation level > or =2 within 15 min of the start of drug infusion was estimated as 0.043 microg x kg(-1) x min(-1) (95% confidence interval 0.01, 0.059). The requirement for midazolam decreased with increasing remifentanil dose compared with placebo (P < 0.001). The median time to return to alertness after the end of infusion was 10-12 min in the remifentanil groups and 5 min in the placebo group. Significant incidences of nausea, pruritus, sweating, and respiratory depression were reported during remifentanil infusions compared with placebo. The data suggest that remifentanil may be useful for supplementation of regional anesthesia, provided that ventilation is carefully monitored.
In this dose-finding, placebo-controlled study, remifentanil infusions were used to provide sedation during spinal and brachial plexus regional anesthesia. The 50% effective dose for achievement of sedation was 0.043 microg x kg(-1) x min(-1). Return to alertness occurred after 10-12 min (median time). Remifentanil infusions can be used to supplement regional anesthesia, but this requires careful monitoring of ventilation.
我们使用经过验证的综合警觉性量表，评估了160例接受脊髓阻滞髋关节置换手术（n = 61）或臂丛阻滞手部手术（n = 93）的患者（美国麻醉医师协会身体状况I或II级）持续输注瑞芬太尼的镇静潜力。他们被随机分为双盲方式接受以下初始剂量方案之一：安慰剂或0.04、0.07或0.1微克·千克⁻¹·分钟⁻¹瑞芬太尼，随后根据效果进行滴定。根据需要可额外静脉注射咪达唑仑以达到充分镇静。对两个手术组的综合分析显示，在研究药物输注开始后15分钟内，达到镇静水平≥2的情况呈剂量相关增加；与安慰剂相比，所有瑞芬太尼剂量比较均具有统计学意义（P < 0.001）。药物输注开始后15分钟内达到综合镇静水平≥2的瑞芬太尼50%有效剂量估计为0.043微克·千克⁻¹·分钟⁻¹（95%置信区间0.01，0.059）。与安慰剂相比，随着瑞芬太尼剂量增加，咪达唑仑的需求减少（P < 0.001）。输注结束后恢复警觉的中位时间在瑞芬太尼组为10 - 12分钟，在安慰剂组为5分钟。与安慰剂相比，瑞芬太尼输注期间报告了恶心、瘙痒、出汗和呼吸抑制的显著发生率。数据表明，只要仔细监测通气，瑞芬太尼可能有助于补充区域麻醉。
在这项剂量探索性、安慰剂对照研究中，瑞芬太尼输注用于在脊髓和臂丛区域麻醉期间提供镇静。达到镇静的50%有效剂量为0.
