Target-Controlled Infusion for Remifentanil in Vascular Patients Improves Hemodynamics and Decreases Remifentanil Requirement
Target-Controlled Infusion for Remifentanil in Vascular Patients Improves Hemodynamics and Decreases Remifentanil Requirement
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血管患者瑞芬太尼靶控输注可改善血流动力学并减少瑞芬太尼需求
DOI：
10.1213/00000539-200301000-00008
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发表时间：
2003
影响因子：
5.7
通讯作者：
P. Coriat
中科院分区：
文献类型：
--
作者：
V. de Castro;G. Godet;Gonzalo Mencia;M. Raux;P. Coriat
瑞芬太尼是一种强效的超短效阿片类药物，可迅速起效。然而，瑞芬太尼是昂贵的，并且在过量的情况下可能对血液动力学具有不利影响。靶控输注（TCI）允许根据药代动力学模型调整输注。在这项前瞻性随机研究中，我们比较了计划进行颈动脉手术的患者的术中和术后血流动力学、麻醉期间瑞芬太尼需求量和术后吗啡需求量，并接受瑞芬太尼的连续IV体重调整输注（RIVA）或瑞芬太尼的TCI（TCIR）。46例患者入组本研究：所有患者均采用丙泊酚靶控输注麻醉。其中23例采用RIVA（0.5 g · kg-1 · min-1）诱导麻醉和气管插管，插管后将输注速率降至0.25 g · kg-1 · min-1，然后根据血流动力学调整为0.05 g · kg-1 · min-1。23例患者接受TCIR（Minto模型，Rugloop），诱导期间效应部位浓度为4 ng/mL，然后根据血流动力学逐步调整为1 ng/mL。所有患者均接受阿曲库铵和50%的N2 O/O2混合物。每分钟记录血流动力学变量。记录两组患者血流动力学事件的数量和持续时间，并记录麻醉剂（瑞芬太尼和丙泊酚）和血管活性药物的总剂量。通过使用非配对t检验分析数据。与TCIR相比，RIVA与更频繁的术中低血压事件（16对6，P < 0.001）和更频繁的术后高血压和/或心动过速事件（16对10，P < 0.04）显著相关，需要更频繁地使用β-肾上腺素能受体阻滞剂。吗啡滴定的需要在两组之间没有显著差异。TCIR组瑞芬太尼用量显著减少（700 ± 290 vs 1390 ± 555 g，P < 0.001），而丙泊酚用量无差异。这项前瞻性随机研究表明，在颈动脉内膜切除术期间，与使用连续RIVA接受瑞芬太尼的患者相比，TCI导致麻醉诱导期间的痉挛发作较少，心动过速和/或高血压发作较少，恢复期间对肾上腺素能阻滞剂的需求较少，瑞芬太尼需求减少。颈动脉内膜切除术中瑞芬太尼给药首选TCI的建议可能是合理的。
Remifentanil is a potent ultra-short-acting opioid, which permits rapid emergence. However, remifentanil is expensive and may have detrimental effects on hemodynamics in case of overdose. Target-controlled infusion (TCI) permits adapting infusion to pharmacokinetic models. In this prospective randomized study, we compared intra- and postoperative hemodynamics, remifentanil requirement during anesthesia, and postoperative morphine requirement in patients scheduled for carotid surgery, and receiving either continuous IV weight-adjusted infusion of remifentanil (RIVA) or TCI for remifentanil (TCIR). Forty-six patients were enrolled in this study: all were anesthetized by using TCI for propofol. Twenty-three received RIVA (0.5 &mgr;g · kg−1 · min−1) for the induction of anesthesia and endotracheal intubation, with the infusion rate decreased to 0.25 &mgr;g · kg−1 · min−1 after intubation, then adapted by step of 0.05 &mgr;g · kg−1 · min−1 according to hemodynamics. Twenty-three patients received TCIR (Minto model, Rugloop), with an effect-site concentration at 4 ng/mL during induction, then adapted by step of 1 ng/mL according to hemodynamics. All patients received atracurium and a 50% mixture of N2O/O2. Hemodynamic variables were recorded each minute. The number and duration of hemodynamic events were collected, and total doses of anesthetics (remifentanil and propofol) and vasoactive drugs were noted in both groups of patients. Data were analyzed by using unpaired t-tests. RIVA was significantly associated with more frequent episodes of intraoperative hypotension (16 versus 6, P < 0.001) and more frequent episodes of postoperative hypertension and/or tachycardia requiring more frequent administration of &bgr;-adrenergic blockers (16 vs 10, P < 0.04) in comparison with TCIR. The need for morphine titration was not significantly different between groups. TCIR led to a significantly smaller requirement of remifentanil (700 ± 290 versus 1390 ± 555 &mgr;g, P < 0.001) without difference in propofol requirement. This prospective randomized study demonstrated that, during carotid endarterectomy, in comparison with patients receiving remifentanil using continuous RIVA, TCI results in less hypotensive episodes during the induction of anesthesia, in fewer episodes of tachycardia and/or hypertension and a smaller &bgr;-adrenergic blocker requirement during recovery, and a decrease in remifentanil requirement. Recommendations to prefer TCI for remifentanil administration during carotid endarterectomy may be justified.