Remifentanil and fentanyl during anaesthesia for major abdominal and gynaecological surgery. An open, comparative study of safety and efficacy
Remifentanil and fentanyl during anaesthesia for major abdominal and gynaecological surgery. An open, comparative study of safety and efficacy
复制标题
DOI：
10.1046/j.1365-2346.2001.00929.x
复制
发表时间：
2001-09
影响因子：
3.6
通讯作者：
J. R. Sneyd;F. Camu;A. Doenicke;C. Mann;O. Holgersen;J. Helmers;L. Appelgren;D. Noronha;B. Upadhyaya
中科院分区：
文献类型：
--
作者：
J. R. Sneyd;F. Camu;A. Doenicke;C. Mann;O. Holgersen;J. Helmers;L. Appelgren;D. Noronha;B. Upadhyaya
背景与目的本开放的多中心研究比较了瑞芬太尼和芬太尼在0.8%异氟醚（潮汐末浓度）的平衡麻醉下用于腹部和妇科大手术的疗效和安全性，以及瑞芬太尼用于术后疼痛管理的疗效和安全性。方法将286例患者随机分为瑞芬太尼1 μg kg-1 + 0.2 μg kg-1 min-1组（98例）、瑞芬太尼2 μg kg-1 + 0.4 μg kg-1 min-1组（91例）和芬太尼3 μg kg-1组（97例）。然后，在手术过程中滴定阿片类药物和异氟醚的作用。结果与芬太尼相比，瑞芬太尼2 g kg -1后再用0.4 g kg -1 min-1分别降低了气管插管（30%比13%，P < 0.01）、皮肤切开（33%比4%，P < 0.001）和皮肤闭合（11%比3%，P < 0.05）的发生率。接受瑞芬太尼1 g kg -1后再接受0.2 g kg -1 min-1的患者对皮肤切开的反应低于芬太尼组（12%比33%，P < 0.001），但对气管插管和皮肤闭合的反应发生率相似。与芬太尼相比，瑞芬太尼组和芬太尼组术中对手术应激反应≥1的患者显著减少（68%和48% vs. 87%, P < 0.003）。与芬太尼组相比，瑞芬太尼组所需的异氟烷平均浓度较低（0.1%,P =0.05）。在接受瑞芬太尼治疗的患者中，继续以0.1 μg kg-1 min-1滴注，滴注量为±0.025 μg kg-1 min-1，在转移到吗啡镇痛之前，可以有效地治疗术后立即疼痛。然而，高比例的患者经历了至少中度疼痛，而滴定进行。结论异氟醚联合瑞芬太尼连续输注麻醉对手术刺激反应的钝化效果明显优于芬太尼。0.4 μg kg-1 min-1瑞芬太尼气管插管应答的患者明显减少，支持插管前采用更高的初始输注速率。瑞芬太尼和芬太尼均具有良好的耐受性，并伴有μ-阿片类激动剂的典型不良事件。
Background and objective This open, multicentre study compared the efficacy and safety of remifentanil with fentanyl during balanced anaesthesia with 0.8% isoflurane (end-tidal concentration) for major abdominal and gynaecological surgery, and the efficacy and safety of remifentanil for pain management in the immediate postoperative period. Methods Two-hundred and eighty-six patients were randomized to receive remifentanil 1 μg kg–1 followed by 0.2 μg kg–1 min–1 (n =98), remifentanil 2 μg kg–1 followed by 0.4 μg kg–1 min–1 (n =91) or fentanyl 3 μg kg–1 (n =97) at induction. Thereafter, the study opioids and isoflurane were titrated to effect during the operation. Results Compared with fentanyl, remifentanil 2 g kg–1 followed by 0.4 g kg –1 min–1 reduced the incidence of response to tracheal intubation (30% vs. 13%, P < 0.01), skin incision (33% vs. 4%, P < 0.001) and skin closure (11% vs. 3%, P < 0.05), respectively. Patients receiving remifentanil 1 g kg–1 followed by 0.2 g kg –1 min–1 had fewer responses to skin incision than the fentanyl group (12% vs. 33%, P < 0.001), but the incidences of response to tracheal intubation and skin closure were similar. Significantly fewer patients in both remifentanil groups had ≥ 1 responses to surgical stress intraoperatively compared with fentanyl (68% and 48% vs. 87%, P < 0.003). The mean isoflurane concentrations required were less in both remifentanil groups compared with the fentanyl group (0.1%, P =0.05). In remifentanil-treated patients, continuation of the infusion at 0.1 μg kg–1 min–1 with titration increments of ± 0.025 μg kg–1 min–1 was effective for the management of immediate postoperative pain prior to transfer to morphine analgesia. However, a high proportion of patients experienced at least moderate pain whilst the titration took place. Conclusions Anaesthesia combining isoflurane with a continuous infusion of remifentanil was significantly more effective than fentanyl at blunting responses to surgical stimuli. Significantly fewer patients responded to tracheal intubation with remifentanil at 0.4 μg kg–1 min–1, supporting the use of a higher initial infusion rate before intubation. Both remifentanil and fentanyl were well-tolerated, with reported adverse events typical of μ-opioid agonists.