The optimal effect-site concentration of remifentanil to attenuate the pain caused by propofol
The optimal effect-site concentration of remifentanil to attenuate the pain caused by propofol
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DOI：
10.4097/kjae.2012.63.2.108
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发表时间：
2012-08-01
影响因子：
2.9
通讯作者：
Chun, Duk-Hee
中科院分区：
文献类型：
--
作者：
Lee, Jong-Yeon;Yang, HyeonJeong;Chun, Duk-Hee
背景：异丙酚注射引起的疼痛是一种常见且众所周知的不良反应。本研究旨在确定瑞芬太尼的最佳效应部位浓度，以减少异丙酚诱导时的注射疼痛。方法：全麻患者采用全静脉麻醉技术，经瑞芬太尼预处理至一定目标浓度后再注射异丙酚。采用Dixon上下法，根据患者描述的疼痛程度调整下一位患者的瑞芬太尼靶浓度。通过10条成功-失败曲线（交叉曲线）来寻找瑞芬太尼对减少异丙酚注射疼痛的效应位点浓度（EC）。结果：瑞芬太尼在50%和95%的成年女性人群中减轻异丙酚注射疼痛的EC （EC50和EC95）分别为3.09 ng/ml（95%置信区间[CI] 2.92 ~ 3.30 ng/ml）和3.78 ng/ml （95% CI 3.45 ~ 3.95 ng/ml）。瑞芬太尼输注过程中未发现有临床意义的血流动力学损害或呼吸系统并发症。结论：异丙酚诱导期间维持瑞芬太尼EC值3.78 ng/ml，可减轻女性全麻患者异丙酚注射疼痛，无严重不良反应，可使患者在不需其他药物缓解疼痛的情况下感到舒适。
Background: The injection pain of propofol is a frequent and well-known adverse effect. This study was designed to determine the optimal effect-site concentration of remifentanil for minimizing injection pain during induction with propofol.Methods: A total intravenous anesthetic technique was used for patients undergoing general anesthesia and remifentanil was pretreated to reach a certain target concentration before propofol injection. Using Dixon's up-anddown method, the degree of pain described by the patient was used to adjust the target concentration of remifentanil for the next patient. Ten success-failure curves (crossovers) were sought to find the effect-site concentration (EC) of remifentanil for minimizing injection pain of propofol.Results: The EC of remifentanil in 50% and 95% of adult female population (EC50 and EC95) for minimizing injection pain of propofol were 3.09 ng/ml (95% confidence limits [CI] 2.92-3.30 ng/ml) and 3.78 ng/ml (95% CI 3.45-3.95 ng/ml), respectively. Clinically significant hemodynamic compromise or respiratory complications were not found during remifentanil infusion.Conclusions: Maintaining 3.78 ng/ml EC of remifentanil during induction with propofol attenuate propofol injection pain without serious adverse events in female patients undergoing general anesthesia and this method may provide the patient's comfort without preparing other drugs for pain relief.