Effects of dexmedetomidine on the effect-site concentration of remifentanil for successful laryngeal mask insertion in women
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摘要: 目的 探讨右美托咪定对女性患者成功置入喉罩时所需瑞芬太尼效应室浓度的影响,为右美托咪定用于保留自主呼吸的全麻提供临床依据。 方法 选取择期行妇科宫腔镜诊治术患者48例,分为实验组(D组)和对照组(P组)。麻醉诱导前2组分别恒速静脉泵注试验药物10 min,D组试验药物为右美托咪定0.5 μg/kg,P组则为相同容量的生理盐水,之后通过效应室靶控输注药物,首先输注丙泊酚,3 min后给予瑞芬太尼,2组瑞芬太尼均给予2 μg/ml的初始靶浓度。记录置入喉罩是否出现反应,根据Dixon序贯法原则决定下一病例的瑞芬太尼靶浓度(采用等比数据,等比比值1:0.85),由此计算瑞芬太尼EC50值。记录输注试验药物前(T0)、试验药物输注完毕后3 min(T1)、瑞芬太尼TCI达靶浓度后喉罩置入前(T2)、成功置入喉罩后1 min(T3)、成功置入喉罩后5 min(T4)的呼吸循环参数。 结果 成功置入喉罩时,P组和D组的瑞芬太尼效应室浓度EC50分别为2.74 μg/ml(95%CI:2.30~3.36 μg/ml)和1.13 μg/ml(95%CI:0.91~1.38 μg/ml),差异有统计学意义(P<0.05)。靶控输注瑞芬太尼后,P组较D组血压显著下降(T2,P<0.001;T4,P=0.002);在应用右美托咪定后T1、T3、T4时点D组心率明显低于P组(P<0.001)。置入喉罩前后,D组呼吸暂停发生率均明显低于P组(置入前:36.36% vs. 76.92%,P=0.003;置入后:16.67% vs. 66.67%,P=0.018)。 结论 给予0.5 μg/kg的右美托咪定可有效减少瑞芬太尼成功置入喉罩时的EC50值,对于全身麻醉应用喉罩后成功保留自主呼吸有积极意义,值得推广。Abstract: Objective To investigate the effects of dexmedetomidine on effect-site concentration of remifentanil for successful laryngeal mask (LMA) insertion in women and to provide clinical basis in the application of dexmedetomidine to general anesthesia retaining spontaneous respirations. Methods Forty-eight patients scheduled for hysteroscopic examinations were randomly allocated to experiment group (group D) and control group (group P).At the beginning of anesthesia induction,experimental drugs (dexmedetomidine 0.5 μg/kg in group D;normal saline in group P) were intravenously administrated at a constant velocity for 10 min by an infusion pump in each group.Propofol was effect-site target controlled infused following saline and dexmedetomidine administration completion.Three minutes after propofol infusion,remifentanil was effect-site target controlled infused and the initial concentration was set at 2.0 μg/ml in both groups.The status of LMA insertion was recorded,and according to the recorded status,the target remifentanil concentration of the following patient was determined by Dixon's up-and-down method (ratio is 1:0.85),and then EC50 of remifentanil was determined.The respiratory and circulatory parameters at each stage (T0:before applying dexmedetomidine or saline;T1:3 min after applying dexmedetomidine or saline;T2:after TCI of remifentanil and before LMA insertion;T3:1 min after LMA insertion;T4:5 min after LMA insertion) were recorded and compared. Results Effect-site EC50 values of remifentanil for successful LMA insertion were 2.74 μg/ml (95%CI:2.30-3.36 μg/ml) for group D and 1.13 μg/ml (95%CI:0.91-1.38 μg/ml) for group P (P<0.05).After TCI of remifentanil,SBP in group P was significantly lower than that in group D (T2,P=0;T4,P=0.002);HR in group D was significantly lower than that in group P at T1,T3,T4 after dexmedetomidine was administered (T1,T3,T4,P=0).The incidence of apnea in group D was significantly lower than that in group P whether before (36.36% vs.76.92%,P=0.003) or after (16.67% vs.66.67%,P=0.018) LMA insertion. Conclusion Dexmedetomidine can significantly reduce the EC50 values of remifentanil for successful LMA insertion,and beneficial to preserve spontaneous respiration in general anesthesia with LMA airway,worthy of clinical application.
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Key words:
- Dexmedetomidine /
- Laryngeal mask /
- Remifentanil /
- Target controlled infusion
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