Accidental injection of remifentanil can cause a much more dangerous situation than the same dose of fentanyl
Accidental injection of remifentanil can cause a much more dangerous situation than the same dose of fentanyl
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意外注射瑞芬太尼会导致比相同剂量芬太尼危险得多的情况
DOI：
10.1007/s00540-010-1008-0
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发表时间：
2010
期刊：
影响因子：
2.8
通讯作者：
Iwasaki H、
中科院分区：
文献类型：
--
作者：
Kunisawa T;Nagashima M;Suzuki A;Takahata O;Iwasaki H、
致编辑：瑞芬太尼的作用持续时间显然比芬太尼短得多。瑞芬太尼的分布体积比芬太尼小得多，与芬太尼相比，瑞芬太尼的消除半衰期极短[1,2]。芬太尼丸注射可用于缓解由侵入性手术引起的疼痛，如硬膜外置管。根据一些报道，每公斤芬太尼摄入2微克被认为是安全的[3,4]。如果将该剂量的芬太尼给予患者（假设为50岁，身高150厘米，体重50公斤的女性）进行药代动力学（PK）模拟，则使用药物动力学模型TIVA Trainer version 8 （http://www）计算效应位点浓度（ESC）。eurosiva。组织;Shafer参数[1]的计算间隔为1 s)，注射后从未达到2 ng/ ml，这被认为是对呼吸没有影响的最大浓度（图1）。相反，如果用同样剂量的瑞芬太尼代替芬太尼，会发生什么？用Minto参数[2]进行PK，结果表明瑞芬太尼的ESC可达7.08 ng/mL，并在7 min 19 s内保持在2 ng/mL以上（图1）。由于上述浓度的瑞芬太尼容易引起呼吸抑制，因此不小心注射瑞芬太尼可能会造成危急情况。这是因为瑞芬太尼的等离子体效应位平衡常数ke0较大，而瑞芬太尼的快速分布体积小于芬太尼。因此，即使在上述简单的情况下，为了避免风险，也需要了解PK，并且不应进行2 μg/kg的瑞芬太尼批量注射。
To the Editor: The duration of the action of remifentanil is clearly much shorter than that of fentanyl. The distribution volume of remifentanil is much smaller than that of fentanyl and the elimination half-life of remifentanil is extremely short compared with that of fentanyl [1, 2]. Bolus injection of fentanyl can be used for relief from pain caused by an invasive procedure such as epidural catheterization. Two micrograms per kilogram of fentanyl is considered to be safe based on some reports [3, 4]. If that dose of fentanyl is administered to a patient (assumed to be a 50-year-old female with a height of 150 cm and weight of 50 kg) for pharmacokinetic (PK) simulation, the effect-site concentration (ESC) calculated using the pharmacokinetic model TIVA Trainer version 8 (http://www. eurosiva. org; calculation interval of 1 s) with Shafer’s parameter [1] never reaches 2 ng/mL—which is considered to be the maximum concentration that has no effect on respiration—after bolus injection (Fig. 1). In contrast, if the same dose of remifentanil was used instead of fentanyl, what would happen? PK with Minto’s parameter [2] shows that the ESC of remifentanil can reach 7.08 ng/mL and remains over 2 ng/mL for 7 min and 19 s (Fig. 1). Since the above concentration of remifentanil can easily cause respiratory depression, an accidental injection of remifentanil may cause a critical situation.This occurs because ke0 (the plasma effect-site equilibrium constant) of remifentanil is larger and the rapid distribution volume of remifentanil is smaller than those of fentanyl. Thus, knowledge of PK is required in order to avoid risk even in a simple situation such as the above example, and the bolus injection of 2 μg/kg of remifentanil should not be performed.
影响因子：
8.8
作者：
Minto, CF;Schnider, TW;Shafer, SL
通讯作者：
Shafer, SL
静脉注射咪达唑仑、芬太尼或氯胺酮对硬膜外麻醉镇痛效果的影响[J].
DOI：
--
发表时间：
2009
期刊：
Masui. The Japanese journal of anesthesiology
影响因子：
--
作者：
Tadanori Terada;K. Hara;T. Sata
通讯作者：
T. Sata
影响因子：
8.8
作者：
SHAFER, SL;VARVEL, JR;SCOTT, JC
通讯作者：
SCOTT, JC