Sevoflurane - nitrous oxide anaesthesia supplemented with remifentanil: effect on recovery and cognitive function
Sevoflurane - nitrous oxide anaesthesia supplemented with remifentanil: effect on recovery and cognitive function
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DOI：
10.1046/j.1365-2044.2001.01795.x
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发表时间：
2001-02-01
期刊：
影响因子：
10.7
通讯作者：
McBrien, ME
中科院分区：
文献类型：
--
作者：
Breslin, DS;Reid, JE;McBrien, ME
本研究的目的是比较七氟烷或七氟烷补充瑞芬太尼维持麻醉后的恢复和精神状态。所有患者均使用了66%的一氧化二氮。将20例患者随机分配至仅使用维持充分麻醉所需浓度的七氟烷或使用补充瑞芬太尼的1.5、1.0或0.5 MAC（潮气末）七氟烷维持麻醉。后三组所需瑞芬太尼的中位剂量分别为0.21、0.25和0.34（p < 0.05）。mug.kg四组中睁眼的中位时间分别为10.3、12.7、11.0和6.5 min（0.5 MAC组与其他组之间p < 0.05），定向时间分别为12.1、14.9、12.3和8.3 min（0.5和1.5 MAC组之间p < 0.05）。两组间的简易精神状态评估评分或实际出院时间无显著差异。在接受最低浓度七氟烷和最高剂量瑞芬太尼的组中，显著更多的患者可以在15 min时进行临界闪烁融合试验（p < 0.05）。该组患者的胸壁强直发生率也最高（p < 0.003）。我们的结论是，虽然瑞芬太尼与低浓度的七氟烷的使用有利于早期恢复，它不影响从恢复病房出院的时间，并可能与副作用，如胸壁僵硬。
The aim of this study was to compare recovery and psychomotor performance after maintenance of anaesthesia with sevoflurane or sevoflurane supplemented with remifentanil. Sixty-six per cent nitrous oxide was used in all patients. Twenty patients each were randomly allocated to maintenance of anaesthesia with sevoflurane only in concentrations necessary to maintain adequate anaesthesia or with 1.5, 1.0 or 0.5 MAC (end-tidal) of sevoflurane supplemented with remifentanil. The median dosage of remifentanil required in the last three groups was 0.21, 0.25 and 0.34 mug.kg(-1).min(-1), respectively (p < 0.05). The median times to eye opening were 10.3, 12.7, 11.0 and 6.5 min in the four groups (p < 0.05 between the 0.5 MAC and the other groups) and for orientation 12.1, 14.9, 12.3 and 8.3 min, respectively (p < 0.05 between 0.5 and 1.5 MAC groups). There was no significant difference in the mini-mental state assessment scores or the actual discharge times from the recovery ward among the groups. Significantly greater numbers of patients could perform the critical flicker fusion test at 15 min in the group receiving the lowest concentration of sevoflurane and the highest dosage of remifentanil (p < 0.05). Patients in this group also showed the highest incidence of chest wall rigidity (p < 0.003). We conclude that, while the use of remifentanil with lower concentrations of sevoflurane facilitates early recovery, it does not influence discharge time from recovery ward and may be associated with side-effects such as chest wall rigidity.