The Effect of Sedation on Intracranial Pressure in Patients with an Intracranial Space-Occupying Lesion: Remifentanil Versus Propofol
The Effect of Sedation on Intracranial Pressure in Patients with an Intracranial Space-Occupying Lesion: Remifentanil Versus Propofol
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DOI：
10.1213/ane.0b013e3181a3ea3a
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发表时间：
2009-07-01
影响因子：
5.7
通讯作者：
Ruel, Monique
中科院分区：
文献类型：
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作者：
Girard, Francois;Moumdjian, Robert;Ruel, Monique
背景技术背景：在这项研究中，我们比较了瑞芬太尼与异丙酚轻度镇静对区域麻醉下立体定向脑肿瘤活检患者颅内压（ICP）和脑灌注压（CPP）的影响。将40例在区域麻醉下接受立体定向脑肿瘤活检的患者随机分为两组，分别接受瑞芬太尼或丙泊酚滴定至改良清醒/镇静量表评估的4级。结果：在目标镇静水平，瑞芬太尼和丙泊酚的输注速率分别为4.2 +/- 1.8 μ g。kg（-1）。h（-1）和4.3 ± 2.5 mg . kg（-1）。h（-1）。在测量ICP时，瑞芬太尼组患者的呼吸频率（11/min +/- 3 vs 15/min +/- 3，P = 0.0001）和PCO 2（48.3 +/- 6.2 mm Hg vs 43.1 +/- 5.5 mm Hg，P = 0.009）均低于丙泊酚组。两组的平均值相似，瑞芬太尼和丙泊酚分别为19.0 +/- 11.9 mm Hg和16.4 +/- 11.1 mm Hg（P = 0.48）。瑞芬太尼组平均动脉压升高（101.1 +/- 13.7 mm Hg vs 85.8 +/- 12.7 mm Hg，P = 0.0008）导致CPP高于丙泊酚组：82.0 +/- 19.0 mm Hg vs 69.5 +/- 17.0 +/- 19.0 mm Hg结论：在立体定向脑肿瘤活检术患者中，瑞芬太尼轻度镇静不会导致ICP高于丙泊酚。瑞芬太尼可能更好地保护CPP。（Anesth Analg 2009：109：194-8）
BACKGROUND: In this study, we compared the effect of light sedation with remifentanil versus propofol on intracranial (ICP) and cerebral perfusion pressure (CPP) of patients undergoing stereotactic brain tumor biopsy under regional anesthesia.METHODS: This was a prospective, open-label, randomized, and controlled study. Forty patients undergoing stereotactic brain tumor biopsy under regional anesthesia were randomized into two groups to receive remifentanil or propofol titrated to a level of four on the modified Assessment of Alertness/Sedation Scale. ICP was measured via the biopsy needle.RESULTS: At the targeted level of sedation, the rates of infusion for remifentanil and propofol were, respectively, 4.2 +/- 1.8 mu g . kg(-1) . h(-1) and 4.3 +/- 2.5 mg . kg(-1) . h(-1). At the time of ICP measurement, patients in the remifentanil group had a slower respiratory rate (11/min +/- 3 vs 15 per min +/- 3, P = 0.0001) and a higher PCO2 (48.3 +/- 6.2 mm Hg vs 43.1 +/- 5.5 mm Hg, P = 0.009) than patients in the propofol group. The mean was similar for both groups, 19.0 +/- 11.9 mm Hg vs 16.4 +/- 11.1 mm Hg for remifentanil and propofol, respectively (P = 0.48). Higher mean arterial blood pressure in the remifentanil group (101.1 +/- 13.7 mm Hg vs 85.8 +/- 12.7 mm Hg, P = 0.0008) resulted in a higher CPP than the propofol group: 82.0 +/- 19.0 mm Hg vs 69.5 +/- 17.0 +/- 19.0 mm Hg (P = 0.03).CONCLUSION: Light sedation with remifentanil does not result in a higher ICP than propofol in patients undergoing stereotactic brain tumor biopsy. CPP might be better preserved with remifentanil. (Anesth Analg 2009:109:194-8)