The effect of adding two target‐controlled concentrations (1–3 ng mL−1) of remifentanil on MACBAR of desflurane*
The effect of adding two target‐controlled concentrations (1–3 ng mL−1) of remifentanil on MACBAR of desflurane*
复制标题
添加两种目标控制浓度（1–3 ng mL−1）瑞芬太尼对地氟烷 MACBAR 的影响*
DOI：
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发表时间：
2006
影响因子：
3.6
通讯作者：
Giorgio Torri
中科院分区：
文献类型：
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作者：
Andrea Albertin;E. Dedola;P. Bergonzi;F. Lombardo;T. Fusco;Giorgio Torri
背景和目标：这项前瞻性、随机、双盲研究的目的是确定添加两种不同目标对照浓度的瑞芬太尼（1和3 ng mL−1）对地氟烷需求的影响，以减弱手术切口后的交感神经反应（最低麻醉浓度（MACBAR））。研究方法：入选了67例患者，年龄20-50岁，阿萨I，接受择期腹部手术的全身麻醉，并随机分配至无瑞芬太尼输注组（n = 21）或靶控效应部位浓度为1 ng mL−1（n = 24）或3 ng mL−1瑞芬太尼组（n = 22）。所有患者均采用丙泊酚、顺式利多卡因和地氟醚与60%氧化亚氮混合氧进行麻醉。在稳定潮气末地氟烷和目标控制瑞芬太尼浓度20分钟后，测定对手术切口的交感神经反应。使用上下序贯分配技术确定每组的预定呼气末地氟烷浓度和MACBAR。结果如下：未接受瑞芬太尼组的地氟烷MACBAR（6.25% [95%置信区间：5.9-6.5%]）高于接受1 ng mL−1（2.7% [2.6-2.8%]; P < 0.001）和3 ng mL−1瑞芬太尼组（2% [1.9-2.2%]; P < 0.01）。当考虑该年龄人群的MAC值和60%一氧化二氮（0.55 MAC）的贡献时，三组的合并MACBAR值（表示为MAC的倍数）分别为1.9、0.8和0.6 MAC。结论：1 ng mL−1瑞芬太尼的目标控制浓度导致地氟烷与60%一氧化二氮组合的MACBAR降低57%。将瑞芬太尼的目标浓度增加至3 ng mL−1，地氟烷的MACBAR值进一步降低26%。
Background and objectives: The aim of this prospective, randomized, double‐blind study was to determine the effects of adding two different target‐controlled concentrations of remifentanil (1 and 3 ng mL−1) on the desflurane requirement for blunting sympathetic responses after surgical incision (minimum anaesthetic concentration (MACBAR)). Methods: 67 patients, aged 20–50 yr, ASA I, undergoing general anaesthesia for elective abdominal surgery were enrolled and randomly allocated to receive no remifentanil infusion (n = 21) or a target‐controlled effect‐site concentration of 1 ng mL−1 (n = 24) or 3 ng mL−1 remifentanil (n = 22). All patients were anaesthetized with propofol, cisatracurium and desflurane with a mixture of 60% nitrous oxide in oxygen. Sympathetic responses to surgical incision were determined after a 20‐min period of stable end‐tidal desflurane and target‐controlled remifentanil concentrations. Predetermined end‐tidal desflurane concentrations and the MACBAR for each group were determined using an up‐and‐down sequential‐allocation technique. Results: The MACBAR of desflurane was higher in the group receiving no remifentanil (6.25% [95% confidence interval: 5.9–6.5%]) as compared with patients of the groups receiving 1 ng mL−1 (2.7% [2.6–2.8%]; P < 0.001) and 3 ng mL−1 remifentanil (2% [1.9–2.2%]; P < 0.01). When considering a MAC value in this age population and the contribution of 60% nitrous oxide (0.55 MAC), the combined MACBAR values, expressed as multiples of the MAC, were 1.9, 0.8 and 0.6 MAC, in the three groups, respectively. Conclusion: A target‐controlled concentration of 1 ng mL−1 remifentanil results in a 57% decrease in the MACBAR of desflurane combined with 60% nitrous oxide. Increasing the target concentration of remifentanil to 3 ng mL−1 produces a further 26% decrease in the MACBAR values of desflurane.