Respiratory depression effect-site concentration of remifentanil used in combination with different target concentrations of propofol in patients undergoing neurosurgical surgery
10.3760/cma.j.issn.0254-1416.2009.09.008
- VernacularTitle:复合不同靶浓度异丙酚时瑞芬太尼引起神经外科手术病人呼吸抑制的效应室浓度
- Author:
Jia DONG
;
Baoguo WANG
- Publication Type:Journal Article
- Keywords:
Piperidines;
Respiratory insufficiency;
Propofol;
Drug delivery systems
- From:
Chinese Journal of Anesthesiology
2009;29(9):796-799
- CountryChina
- Language:Chinese
-
Abstract:
Objective To determine the respiratory depression effect-site concentration (Ce) of remifentanil when used in combination with different target concentrations of propofol in patients undergoing neurosurgical surgery. Method Eighty patients aged 18-64 yr weighing 45-90 kg scheduled for elective neurosurgical surgery were randomly divided into 4 groups (n = 20 each): remifentanil group (group R), remifentanil combined with propefol 1, 1.5, 2 μg/ml group (group RP1, RP1.5, RP2). In group R, RP1, RP1.5 or RP2, the patients received propofol by TCI at target plasma concentration (Cp) of 0, 1, 1.5 or 2 μg/ml respectively, when the preset concentration was reached, received remifentanil via TCI at the initial target Cp of 2 ng/ml, and the concentration was then increased in the increment of 2 ng/ml at 3 min intervals until respiratory depression was achieved. Respiratory depression was defined as one of the following end points: muscle rigidity, RR<6 bpm, MV < 3 L/min, PETCO_2> 55 mm Hg, SpO_2 < 90% or apnea > 15 s. The Ce of remifentanil, amount of remifentanil used and side effects were recorded during respiratory depression. Result The respiratory depression Ce of remifentanil were (5.2±2.1), (3.2±1.0), (2.9 ±1.3) and (2.2±1.0) ng/ml in group R, RP1, RP1,5 and RP2 respectively. Compared with group R, the respiratory depression Ce of remifentanil were significantly decreased in group RP1, RP1.5 and RP2 (P<0.01). Compared with group RP1 and RP1.5, the respiratory depression Ce of remifentanil was significantly decreased in group RP2(P<0.01). There was no significant difference in respiratory depression Ce of remifentanil between group RP1 and RP1.5 (P > 0.05). Conclusion The respiratory depression Ce of remifentanil is (5.2±2.1) μg/ml in patients without sedation. The respiratory depression Ces of remifentanil are (3.2 ±1.0), (2.9 ± 1.3) and (2.2 ±1.0) ng/ml in patients under sedation with propofoi at target Cps of 1, 1.5, 2 μg/ml during neurosurgical surgery.
