无肌松药条件下七氟烷诱导时右美托咪定对瑞芬太尼维持最佳气管插管条件的半数有效血浆浓度的影响

doi:10.12092/j.issn.1009-2501.2019.08.012

中国临床药理学与治疗学 ›› 2019, Vol. 24 ›› Issue (8): 922-927.doi: 10.12092/j.issn.1009-2501.2019.08.012

无肌松药条件下七氟烷诱导时右美托咪定对瑞芬太尼维持最佳气管插管条件的半数有效血浆浓度的影响

廖朝霞，周礼生，陆福鼎，李玉娟

中山大学孙逸仙纪念医院麻醉科，广州 510120，广东

收稿日期:2019-04-15 修回日期:2019-06-27 出版日期:2019-08-26 发布日期:2019-08-30
通讯作者: 周礼生，男，硕士，医师，研究方向：疼痛与麻醉学。 Tel：13672439429 E-mail：zhoulisheng2@sina.com E-mail:zhoulisheng2@sina.com
作者简介:廖朝霞，女，硕士，医师，研究方向：临床麻醉学。 Tel：15017558421 E-mail：clarice.liao@163.com
基金资助:
广东省自然科学基金(2016A030313251；2018A0303130272)

Effects of dexmedetomidine on the median effective plasma concentration of remifentanil for excellent tracheal intubation during sevoflurane induction without neuromuscular blockade

LIAO Zhaoxia, ZHOU Lisheng, LU Fuding, LI Yujuan

Department of Anesthesiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, Guangdong, China

Received:2019-04-15 Revised:2019-06-27 Online:2019-08-26 Published:2019-08-30

摘要/Abstract

摘要：

目的:探讨无肌松药条件下七氟烷诱导时右美托咪定对瑞芬太尼维持最佳气管插管条件的半数有效血浆浓度(Cp50)的影响。方法:择期全麻手术患者45例，采用随机数字表法分为右美托咪定组（D组，n=21）和对照组（C组，n=24）。D组泵注右美托咪定0.6 μg/kg，持续时间15 min，C组泵注等量生理盐水。采用8%七氟烷肺活量法诱导，待眼睑反射消失后，维持呼气末七氟烷浓度（CETSev）为3%，同时瑞芬太尼靶控输注，初始血浆靶浓度分别设置为3 ng/mL（D组）和4 ng/mL（C组），并按照改良Dixon序贯法调整各组下一例瑞芬太尼的浓度(浓度梯度为0.2 ng/mL)，达到瑞芬太尼血浆靶浓度90 s后喉镜检查评估并行气管插管。比较两组的气管插管条件和血流动力学。结果:C组和D组瑞芬太尼维持最佳气管插管条件的Cp50分别为3.079 ng/mL（95% CI 2.898～3.240）和2.468 ng/mL（95% CI 2.239～2.630）。结论:在七氟烷诱导并无肌松药条件下，右美托咪定可使瑞芬太尼维持最佳气管插管条件的靶控Cp50降低19.8%。

关键词: 右美托咪定, 瑞芬太尼, 七氟烷, 气管插管, 靶控输注

Abstract:

AIM: To explore the effects of dexmedetomidine on the 50% effective plasma concentration (Cp50) of remifentanil for excellent tracheal intubation during sevoflurane induction without neuromuscular blockade. METHODS: Forty-five patients undergoing selective general anesthesia were randomly assigned into two groups: infusion of 0.6 μg/kg dexmedetomidine over 15 min (group D, n=21), saline group (group C, n=24)．For induction, 8% sevoflurane induction was immediately begun in vital capacity until the loss of eyelash reflex, with end-tidal sevoflurane 3% subsequently was maintained. And the initial doses of remifentanil target-controlled infusion were set at 3 ng/mL for group D and 4 ng/mL for group C, and were decreased or increased by 0.2 ng/mL in the next patient using the Dixon's up-and-down method based on the success or failure of intubation. Laryngoscopy and intubation were performed, 90 s after achieving the target concentration of remifentanil. Tracheal intubation conditions and hemodynamics were recorded and compared.RESULTS:In group C and group D, the Cp50 of remifentanil for successful tracheal intubation were 3.079 ng/mL（95% CI 2.898-3.240）and 2.468 ng/mL（95% CI 2.239-2.630), respectively. CONCLUSION:Dexmedetomidine contributes to the reduced Cp50 of remifentanil by 19.8% for excellent tracheal intubation during sevoflurane induction without neuromuscular blockade．

Key words: dexmedetomidine, remifentanil, sevoflurane, intubation, target-controlled infusion (TCI)

中图分类号:

R614

廖朝霞，周礼生，陆福鼎，李玉娟. 无肌松药条件下七氟烷诱导时右美托咪定对瑞芬太尼维持最佳气管插管条件的半数有效血浆浓度的影响[J]. 中国临床药理学与治疗学, 2019, 24(8): 922-927.

LIAO Zhaoxia, ZHOU Lisheng, LU Fuding, LI Yujuan. Effects of dexmedetomidine on the median effective plasma concentration of remifentanil for excellent tracheal intubation during sevoflurane induction without neuromuscular blockade[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2019, 24(8): 922-927.

参考文献

［1］Katz JA,Murphy GS.Anesthetic consideration for neuromuscular diseases［J］.Curr Opin Anaesthesiol,2017,30(3):435-440.
［2］Barrons RW,Nguyen LT.Succinylcholine-induced rhabdomyolysis in adults:case report and review of the literature［J］.J Pharm Pract,2018,29:897190018795983.
［3］Larach MG,Klumpner TT,Brandom BW,et al.Succinylcholine use and dantrolene availability for malignant hyperthermia treatment: database analyses and systematic review［J］.Anesthesiology,2019,130(1):41-54.
［4］Bulka CM,Terekhov MA,Martin BJ,et al.Nondepolarizing neuromuscular blocking agents,reversal,and risk of postoperative pneumonia［J］.Anesthesiology,2016,125:647-655.
［5］Goo EK,Lee JS,Koh JC.The optimal exhaled concentration of sevoflurane for intubation without neuromuscular blockade using clinical bolus doses of remifentanil［J］. Medicine,2017,96(9):e6235.
［6］Ono AH,Moura TR,Govêia CS,et al.ED50 of remifentanil for providing excellent intubating conditions when co-administered with a single standard dose of propofol without the use of muscle relaxants in children:dose-finding clinical trial［J］.J Anesth,2018,32(4):493-498.
［7］Heyse B,Proost JH,Hannivoort LN,et al.A response surface model approach for continuous measures of hypnotic and analgesic effect during sevoflurane-remifentanil interaction:quantifying the pharmacodynamic shift evoked by stimulation［J］.Anesthesiology,2014,120:1390-1399.
［8］赵鹏程,徐丽丽,李艳玲.右美托咪定联合靶控输注丙泊酚在肝癌射频消融治疗中的临床效果［J］.中国临床药理学与治疗学,2018,23(6):682-687.
［9］刘若海,韩园,刘启星,等.右美托咪定复合瑞芬太尼对全麻气管拔管反应的影响［J］.中国临床药理学与治疗学,2015,20(7):788-792.
［10］张宁, 郭振中, 程燕. 右美托咪定对肝叶切除患者肝功能、细胞因子及氧化应激的影响［J］. 临床肝胆病杂志, 2017, 33(3): 507-511.
［11］吕娜. 右美托咪定与咪达唑仑对小儿泌尿外科手术麻醉效果和血流动力学的影响比较［J］. 空军医学杂志, 2019, 35(1): 60-64.
［12］Dixon WJ. Staircase bioassay: the up-and-down method ［J］. Neurosci Biobehav Rev, 1991, 15: 47-50.
［13］Muzi M, Robinson BJ, Ebert TJ, et al. Induction of anaesthesia and tracheal intubation with sevoflurane in adults ［J］. Anesthesiology, 1996, 85: 536-543.
［14］Cros AM, Lopez C, Kandel T, et al. Determination of sevoflurane alveolar concentration for tracheal intubation with remifentanil, and no muscle relaxant ［J］. Anaesthesia, 2015, 55(10): 965-969.
［15］He L, Wang X, Zhang XF, et al. Effects of different doses of remifentanil on the end-tidal concentration of sevoflurane required for tracheal intubation in children ［J］. Anaesthesia, 2009, 64(8): 850-855.
［16］He L, Wang X, Zheng S, et al. Effects of dexmedetomidine on sevoflurane requirement for 50% excellent tracheal intubation in children: a randomized, double-blind comparison ［J］. Pediatr Anesth, 2014, 24(9): 987-993.
［17］杨慧芳, 孙建良, 陈淑萍, 等. 右美托咪啶对异丙酚靶控输注时瑞芬太尼抑制喉罩置入反应的半数有效血浆浓度的影响［J］. 浙江临床医学, 2015, (9): 1618-1619.
［18］de Kort EH, Hanff LM, Roofthooft D, et al. Insufficient sedation and severe side effects after fast administration of remifentanil during INSURE in preterm newborns ［J］. Neonatology, 2017, 111(2): 172-176.
［19］Bae JY, Kwak TY, Kim JW, et al. Tracheal intubation without the use of muscle relaxant in severe burn patients using propofol and varying doses of remifentanil ［J］. Korean J Anesthesiol, 2009, 57(1): 26-31.
［20］李婷, 王全, 刘曼. 七氟烷减轻急性肺损伤机制的研究进展［J］. 临床麻醉学杂志, 2017, 33(9): 931-933.

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无肌松药条件下七氟烷诱导时右美托咪定对瑞芬太尼维持最佳气管插管条件的半数有效血浆浓度的影响

Effects of dexmedetomidine on the median effective plasma concentration of remifentanil for excellent tracheal intubation during sevoflurane induction without neuromuscular blockade

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