小儿七氟醚诱导时瑞芬太尼经鼻给药的适宜剂量

目的:比较小儿七氟醚诱导时经鼻给予不同剂量的瑞芬太尼在不使用肌松药情况下所提供的气管插管条件和心血管反应。方法:45例行择期手术患儿,随机均分3组,吸入7%七氟醚1 min后经鼻给予不同剂量瑞芬太尼,分别为2μg/kg(R2,n=15)、μg/kg(R3,n=15)、4μg/kg(R4,n=15),2～3 min后行气管内插管,记录麻醉诱导前、气管插管前、插管后1 min、3 min的平均动脉压和心率,并对插管条件进行评估。结果:全组患儿心率均有不同程度下降,R3和R4组下降明显,R4组平均动脉压显著下降,该组个别患儿需用血管活性药物提升血压和心率;R2组患儿插管后血流动力学波动比R3、R4组明显。R2组气管插管条件满意率低于R3、R4组,差异有统计学意义(P<0.05),R3、R4组间差异无统计学意义(P>0.05)。结论:小儿七氟醚诱导无肌松药气管插管时,经鼻给予瑞芬太尼3μg/kg可提供满意的气管插管条件和稳定的血流动力学。

Proper dose of intranasal administration of remifentanil after sevoflurane induction of anesthesia without relaxants in children

Objective To compare the intubating conditions and airway response to intubation（coughing and/or movement） after intranasal administration of remifentanil following sevoflurane induction without relaxants in children.Method For 45 pediatric patients aged from 1～3 years old were assigned into three groups with different doses of remifentanil,2 μg/kg（R2,n=15）,3 μg/kg（R3,n=15）,2 μg/kg（R4,n=15）.Anesthsia was induced by 7% sevoflurane combined with intrasal remifentanil 2,3,4 μg/kg respectively within 2～3 min.MAP and HR were recorded before induction,before intubation and 1,3 min after intubation.Intubation conditions were also evaluated after intubation.Results There was a significant reduction in MAP and HR after administration of remifentanil compared to those before induction in all groups.There was an increasing HR and MAP in group R2 differed from R3 and R4 after intubation（P〈0.05）.The conditions for laryngoscopy and response to intubation in R2 was not satisfied.Cardiovascular drugs were needed for a stable hemodynamic individually in group R4.Conclusion There are no severe complications associated with the use of nasal remifentanil.The proper dose of nasal remifentanil（3 μg/kg） produces a satified condition of intubation within 2～3 min and a stable hemodynamic during induction of anesthesia in chilren.