Effect of bolus dose of remifentanil on haemodynamic response to tracheal intubation

A randomized placebo-controlled double-blinded study was conducted in 40 ASA 1 and 2 patients to determine the dose response of remifentanil in attenuating the haemodynamic response to tracheal intubation. Patients were allocated to one of four groups: placebo, remifentanil 1 microgram.kg-1, remifentanil 2 micrograms.kg-1 and remifentanil 4 micrograms.kg-1. A propofol target-controlled infusion was started at 4 micrograms.ml-1 and incrementally titrated to loss of verbal contact. Muscle relaxation was provided by cisatracurium. The study drug was given three minutes later over 30 seconds, and 90 seconds later the patient's trachea was intubated under direct laryngoscopy. Baseline noninvasive blood pressure and heart rate recordings were made prior to starting target-controlled infusion, then at one-minute intervals after loss of verbal contact for the duration of the study. Demographic data and target-controlled infusion rate at intubation was similar for the groups. Following intubation, heart rate increased by 15% in the placebo group, 10% in 1 microgram.kg-1 group, with no changes in 2 micrograms.kg-1 and 4 micrograms.kg-1 groups. Systolic blood pressure following intubation increased by 30% in the placebo group, 10% in the 1 microgram.kg-1 group and remained unchanged in the 2 micrograms.kg-1 and 4 micrograms.kg-1 groups. Remifentanil 1 microgram.kg-1 attenuated the rise in heart rate and systolic blood pressure. Remifentanil 2 micrograms.kg-1 blocked the haemodynamic response completely: no further benefit was shown from increasing the dose to 4 micrograms.kg-1.     

曲马多和芬太尼减轻拔除气管导管心血管反应的对照研究

目的 观察芬太尼、曲马多用于减轻麻醉苏醒期及拔除气管导管时心血管反应的作用。方法 30例ASA Ⅰ～Ⅱ级、择期行上腹部手术患者随机分为 A、B、C三组,每组 10例,接受气管插管、静吸复合全麻。缝合腹膜时三组患者分别静注生理盐水10 ml、芬太尼1 μg/kg和曲马多 1 mg/kg。术毕待达到可接受的拔管标准时拔除气管导管。拔管前1分钟记录MAP、HR;拔管后每隔1分钟记录MAP、HR,直至技管后5分钟;静注干预药物至拔管时间。结果 拔管后数分钟内,A组MAP、HR较拔管前显著升高(P<0.05),之后又下降;B、C两组MAP、HR无显著变化(P>0.05),而与A组相比,有显著性差异(P<0.05)。A、B和C三组静注干预药物至拔管时间,后两者明显较前者长(P<0.05)。结论 在上腹部手术,缝合腹膜时静注芬太尼1μg/kg或曲马多1 mg/kg,均可显著减轻麻醉苏醒期及拔除气管导管时的心血管反应,但应注意对呼吸功能的影响。     

全麻苏醒拔管期雷米芬太尼靶控输注对心血管反应的影响

目的观察全麻苏醒拔管期雷米芬太尼靶控输注(TCI)对心血管反应的影响。方法择期行妇科手术患者60例,ASAⅠ~Ⅱ级,随机均分为雷米芬太尼组(A组)和生理盐水对照组(B组)。两组患者均接受丙泊酚、维库溴铵、芬太尼、0·8%~1·0%异氟醚复合50%氧化亚氮的全身麻醉。术毕时送至麻醉复苏室(PACU),A组患者TCI输注雷米芬太尼,血浆浓度为1μg/L,B组TCI输注生理盐水作对照。观察苏醒期患者的平均动脉压(MAP)、HR、呼吸恢复时间、睁眼时间和拔管时间。结果A组患者在吸痰、拔管时MAP、HR无明显变化,B组则明显升高(P<0·05);两组患者呼吸恢复、睁眼、拔管时间差异无显著意义。结论TCI雷米芬太尼可抑制全麻苏醒拔管期的心血管反应,平稳苏醒。     

Respiratory complications associated with tracheal extubationTiming of tracheal extubation and use of the laryngeal mask during emergence from anaesthesia

Sixty patients were randomly allocated to one of three groups and the incidences of respiratory complications which occurred during emergence from anaesthesia were compared under the following three circumstances: tracheal extubation after the patient had regained consciousness (awake group); tracheal extubation while the patient was still anaesthetised (anaesthetised group); and the use of the laryngeal mask during emergence from anaesthesia (mask group). In the mask group, the laryngeal mask was inserted under deep anaesthesia before tracheal extubation and the lungs were ventilated through the laryngeal mask after tracheal extubation. In the awake group, straining (bucking) occurred in 18 patients and desaturation (arterial oxygen haemoglobin saturation < 95%) in two patients. In the anaesthetised group, airway obstruction occurred in 17 patients and desaturation in one of these patients. In the mask group, ventilation through the laryngeal mask was temporarily difficult immediately after tracheal extubation in one patient and coughing occurred before removal of the mask in three patients. No respiratory complications occurred in two patients in the awake group, three patients in the anaesthetised group and 16 patients in the mask group. The incidence of respiratory complications during recovery from anaesthesia was significantly lower in the mask group than in the other two groups (pooled) (p << 0.001). Therefore, the use of the laryngeal mask after tracheal extubation decreases the incidence of respiratory complications during recovery from anaesthesia.     

Effects of landiolol on the cardiovascular response during tracheal extubation

The objective of this study was to investigate the effect of landiolol on the cardiovascular responses to emergence from anesthesia and tracheal extubation. Fifty-nine patients without cardiovascular disorders who were scheduled for tympanoplasty were randomly allocated to receive a loading dose of landiolol at 0.125 mg x kg(-1) x min(-1) for 1 min, followed by an infusion at 0.01 mg x kg(-1) x min(-1) (group L1), 0.02 mg x kg(-1) x min(-1) (group L2), 0.03 mg x kg(-1) x min(-1) (group L3), or 0.04 mg x kg(-1) x min(-1) (group L4). At the end of surgery, sevoflurane and nitrous oxide were discontinued, and landiolol was started. The mean arterial pressure (MAP), heart rate (HR), and rate pressure product (RPP) in the four groups were compared before anesthesia induction, just after extubation, 5 min after extubation, 10 min after extubation, and at discharge from the operating room. Just after extubation compared with the baseline, the MAP increased significantly in all groups; the HR increased in groups L1 and L2; and the RPP increased in all groups, except for group L4. Continuous administration of landiolol, at 0.03 or 0.04 mg x kg(-1) x min(-1), may prevent the increases in HR and RPP, respectively, that occur at the emergence from anesthesia and tracheal extubation.     

雷米芬太尼对老年患者气管插管心血管反应的影响

目的观察不同剂量雷米芬太尼微量泵输注对老年患者气管插管时的心血管反应。方法 60例全麻老年患者随机均分为六组。泵注丙泊酚33 mg/min至意识消失后,Ⅰ、Ⅱ、Ⅲ组分别输注雷米芬太尼0.15、0.20、0.25μg.kg-1.min-1,持续6 min;Ⅳ、Ⅴ、Ⅵ组分别输注雷米芬太尼0.15、0.20、0.25μg.kg-1.min-1,持续8 min。丙泊酚维持量0.12 mg.kg-1.min-1。雷米芬太尼输注结束时静注罗库溴铵0.6 mg/kg,气管插管。记录诱导前(T0)、气管插管前1 min(T1)、气管插管后1 min(T2)、2 min(T3)、3 min(T4)、4 min(T5)、5 min(T6)的SBP、DBP和HR变化。结果与T0时比较,T1时六组SBP、DBP明显下降、HR明显减慢(P0.05或P0.01),T2和T4时Ⅲ、Ⅴ、Ⅵ组HR均明显减慢(P0.05或P0.01)。与T1时比较,T2~T3时Ⅰ、Ⅱ组SBP和DBP、T2~T4时Ⅳ组SBP均明显升高(P0.05或P0.01);Ⅰ、Ⅳ、Ⅴ组T2~T6时、Ⅱ组T2~T3时、Ⅲ组T3~T6时和Ⅵ组T3~T5时的HR明显增快(P0.05或P0.01)。结论老年患者气管插管时,雷米芬太尼复合丙泊酚微量泵输注时,雷米芬太尼以0.20或0.25μg.kg-1.min-1的速度,泵注6 min以上可以有效地抑制气管插管时的心血管反应。     

Bolus dose remifentanil for control of haemodynamic response to tracheal intubation during rapid sequence induction of anaesthesia

The effect of three bolus doses of remifentanil on the pressor response to laryngoscopy and tracheal intubation during rapid sequence induction of anaesthesia was assessed in a randomized, double-blind, placebo- controlled study in four groups of 20 patients each. After preoxygenation, anaesthesia was induced with thiopental 5-7 mg kg-1 followed immediately by saline (placebo) or remifentanil 0.5, 1.0 or 1.25 micrograms kg-1 given as a bolus over 30 s. Cricoid pressure was applied just after loss of consciousness. Succinylcholine 1 mg kg-1 was given for neuromuscular block. Laryngoscopy and tracheal intubation were performed 1 min later. Arterial pressure and heart rate were recorded at intervals until 5 min after intubation. Remifentanil 0.5 microgram kg-1 was ineffective in controlling the increase in heart rate and arterial pressure after intubation but the 1.0 and 1.25 micrograms kg-1 doses were effective in controlling the response. The use of the 1.25 micrograms kg-1 dose was however, associated with a decrease in systolic arterial pressure to less than 90 mm Hg in seven of 20 patients.      

不同剂量雷米芬太尼对气管插管反应的影响

目的 观察不同剂量雷米芬太尼用于全麻诱导气管插管时的心血管反应,探讨其最佳的全麻诱导剂量.方法 将96例择期行腹部手术的患者随机均分为四组.全麻诱导均采用咪唑安定0.06 mg/kg、依托咪酯0.3 mg/kg、维库溴铵0.1 mg/kg;雷米芬太尼剂量分别为1μ9/kg(R1组)、2μg/kg(R2组)、3μ9/kg(R4组)和4μg/kg(R4组).记录诱导前(T0)、诱导后气管插管前(T1)、气管插管后即刻(T2)、气管插管后1min(T3)、2min(T4)、3min(T5)、5min(T6)和10min(T7)的SBP、DBP、HR的变化.结果 与T0比较,各组T1时SBP、DBP均明显下降(P<0.05或P<0.01),R1组T2、T3时SBP显著升高(P<0.05).与T0比较,各组患者T1时的HR均明显减慢(P<0.01),R1组患者T2、T3时HR显著增快(P<0.05或P<0.01).R2、R3组气管插管期间血压波动幅度均较R1、R4组小(P<0.05).结论 采用2～3μg/kg的雷米芬太尼麻醉诱导可有效抑制气管插管时的心血管反应.     

Comparison of different doses of remifentanil on the cardiovascular response to laryngoscopy and tracheal intubation

We have compared three bolus and infusion regimens of remifentanil on the cardiovascular response to laryngoscopy and orotracheal intubation in three groups of 20 ASA I-II female patients, in a randomized, double- blind study. Patients in group 1 received glycopyrolate 200 micrograms i.v. followed by a bolus dose of remifentanil 1 microgram kg-1 over 30 s and an infusion of remifentanil at a rate of 0.5 microgram kg-1 min- 1. The other patients received remifentanil 0.5 microgram kg-1 over 30 s and an infusion of 0.25 microgram kg-1 min-1 with (group 2) or without (group 3) pretreatment with glycopyrrolate 200 micrograms. All patients then received a sleep dose of propofol, rocuronium 0.6 mg kg-1 and 1% isoflurane with 67% nitrous oxide in oxygen. Laryngoscopy and tracheal intubation were performed 3 min later. Heart rate and arterial pressure were recorded at 1-min intervals from before induction of anaesthesia until 5 min after intubation. Baseline heart rate was similar in all groups, but decreased in group 3 (no glycopyrrolate) after induction and remained significantly lower after intubation compared with the other groups (P < 0.05). Heart rate and arterial pressure increased slightly after intubation in each group but there were no significant differences in mean arterial pressure between groups at any time. The incidence of bradycardia (one patient in group 2) and hypotension (two patients in groups 1 and 2 and three patients in group 3) was low.      

Effects of remifentanil and alfentanil on the cardiovascular responses to induction of anaesthesia and tracheal intubation in the elderly

Background. We compared the effects of remifentanil and alfentanilon arterial pressure and heart rate at induction of anaesthesiaand tracheal intubation in 40 ASA I–III patients agedgreater than 65 yr, in a randomized double-blind study. Methods. Patients received either remifentanil 0.5 µgkg^–1 over 30 s, followed by an infusion of 0.1 µgkg min^–1 (group R) or alfentanil 10 µg kg^–1over 30 s, followed by an infusion of saline (group A). Anaesthesiawas then induced with propofol, rocuronium, and 1% isofluranewith 66% nitrous oxide in oxygen. Results. Systolic arterial pressure (SAP) and mean arterialpressure (MAP) decreased after the induction of anaesthesia(P<0.05) and increased for 3 min after intubation in bothgroups (P<0.05), but remained below baseline values throughout.Heart rate remained stable after induction of anaesthesia butincreased significantly from baseline after intubation for 1and 4 min in groups R and A, respectively (P<0.05). Therewere no significant between-group differences in SAP, MAP, andheart rate. Diastolic pressure was significantly higher in groupA than group R at 4 and 5 min after intubation (P<0.05).Hypotension (SAP <100 mm Hg) occurred in four patients ingroup R and three patients in group A. Conclusions. Remifentanil and alfentanil similarly attenuatethe pressor response to laryngoscopy and intubation, but theincidence of hypotension confirms that both drugs should beused with caution in elderly patients. Br J Anaesth 2002; 88: 430–3     

雷米芬太尼靶控输注抑制全麻拔管期心血管不良反应的剂量探讨

目的探讨雷米芬太尼靶控输注(TCI)拔管期有效抑制心血管反应的半数有效血浆浓度(EC50)。方法择期全麻下行腹腔镜胆囊切除术(LC)成人患者40例,按照序贯法TCI血浆浓度分别为0.6、0.8、1.0、1.2和1.4 ng/ml的雷米芬太尼,初始靶浓度为1.0 ng/ml,若患者拔管时SBP高于基础值的20%或HR快于100次/分,或拔管时出现呛咳、躁动,则下一例患者采用高一级浓度的雷米芬太尼TCI;反之则采用低一级浓度的雷米芬太尼TCI。计算全麻拔管期有效抑制心血管反应的雷米芬太尼EC50及其95%可信区间(CI)。结果TCI雷米芬太尼抑制心血管反应的EC50为1.03 ng/ml,其95%CI为0.97~1.09 ng/ml。结论LC全麻拔管期有效抑制心血管反应的雷米芬太尼EC50为1.03 ng/ml。     

右美托咪啶预防全麻气管插管和拔管心血管反应的临床观察

目的 观察右美托咪啶预防全身麻醉气管插管和拔管过程中心血管反应的临床效果。方法 选择30例拟在全身麻醉下行择期腹部手术的患者（ASAⅠ～Ⅱ级）,随机分为2组：对照组（C组）和右美托咪啶组（D组）,每组15例。D组全麻诱导前静脉泵注右美托咪啶1ug/kg,15min泵注完;C组则静脉泵注等量的生理盐水。两组诱导用药均为丙泊酚1.5mg/kg,芬太尼3μg/kg及顺式阿曲库铵0.2mg/kg。记录并比较下列各时间点两组患者的平均动脉压（MAP）、心率（HR）、心率收缩压乘积（RPP）的变化：①注药前（基础值）,DEX或生理盐水输注后5、10、15min;②插管前1min,插管即刻,插管后1、3、5min;③拔管前5min,拔管即刻,拔管后3、5、10min。记录两组插管和拔管期间RPP＞12000的发生情况。结果 D组注药后10、15、插管前1min的HR较基础值下降（P＜0.05）。D组插管即刻、插管后1min、拔管时的MAP和HR均明显低于C组（P＜0.05）。注药后15min至拔管后各时间点D组患者的RPP均低于C组（P＜0.05）。D组在插管和拔管期间RPP＞12000的发生率明显小于C组（P＜0.05）。两组患者的苏醒时间、拔管时间和Ramsay评分比较差异无统计学意义。结论 右美托咪啶能显著减轻气管插管和拔管时的心血管反应,维持血流动力学的稳定,同时对麻醉恢复期没有影响。     

Effect of buprenorphine on the cardiovascular response to tracheal intubation

The effects of buprenorphine on the haemodynamic responses to tracheal intubation were studied in a placebo-controlled double-blind trial in 40 patients who had elective surgery. In one group saline was administered intravenously 8 minutes before induction, whereas the others received buprenorphine 2.5 micrograms/kg intravenously. Anaesthesia was induced in both groups with thiopentone 4 mg/kg followed by suxamethonium 1.5 mg/kg after 90 seconds. In the buprenorphine group, the maximum increase in systolic and diastolic arterial blood pressures, heart rate and rate pressure product were significantly lower compared to the control group. It is concluded that buprenorphine is partially effective in attenuating the cardiovascular response to laryngoscopy and intubation, but does not obliterate it.     

Comparison of effects of remifentanil and alfentanil on cardiovascular response to tracheal intubation in hypertensive patients

In a randomized double-blind study, we compared the effect ofremifentanil and alfentanil on the cardiovascular response tolaryngoscopy and tracheal intubation in patients on long-termtreatment for hypertension. Forty ASA II–III patientswere allocated to receive (i) remifentanil 0.5 µg kg^–1followed by an infusion of 0.1 µg kg min^–1 or (ii)alfentanil 10 µg kg^–1 followed by an infusion ofsaline; all patients received glycopyrrolate 200 µg beforethe study drug. Anaesthesia was induced with propofol and rocuroniumand maintained with 1% isoflurane and 66% nitrous oxide in oxygen.Laryngoscopy and tracheal intubation were performed after establishmentof neuromuscular block. Arterial pressure and heart rate (HR)were measured non-invasively at 1 min intervals from 3 minbefore induction until 5 min after intubation. Systolic(SAP), diastolic and mean arterial pressure decreased significantlyafter induction in both groups (P<0.05). Maximum increasesin mean SAP after laryngoscopy and intubation were 35 and 41mm Hg in the remifentanil and alfentanil groups, respectively.After intubation, arterial pressure did not increase above baselinevalues in either group. HR remained stable after induction ofanaesthesia, but increased above baseline values after intubation.Mean maximum HR was 87 beats min^–1 for the remifentanilgroup (12 beats min^–1 above baseline; P=0.065) and 89beats min^–1 for the alfentanil group (15 beats min^–1above baseline; P<0.05). There were no significant differencesbetween groups in HR or arterial pressure at any time. Therewere no incidences of bradycardia. Seven patients in the remifentanilgroup and four in the alfentanil group received ephedrine forhypotension (i.e. SAP<100 mm Hg). Br J Anaesth 2001; 86: 90–3     

术后泵注瑞芬太尼对围拔管期的影响

目的 探讨术后泵注不同剂量瑞芬太尼对围拔管期患者心血管反应和麻醉恢复的影响.方法 择期行乳腺腺瘤切除术或甲状腺腺瘤切除术患者80例,随机均分为四组,术毕分别将瑞芬太尼泵速减至0.01、0.03、0.05 μg·kg-1 ·min-1 (R1、R2、R3组),C组停止泵注瑞芬太尼.记录瑞芬太尼减量前(T1)、患者清醒吸痰时(T2)和拔管时(T3)的SBP、DBP、HR.观察患者对导管留置的耐受程度以及疼痛VAS评分.结果 与T1时比较,T2、T3时四组患者SBP、DBP明显升高,HR显著增快(P＜0.05).T2、T3时R1、R2、R3组SBP、DBP明显低于C组,HR明显慢于C组(P＜0.05).自主呼吸恢复、睁眼和拔管时间R1、R2、R3组显著长于C组(P＜0.05),R3组显著长于R1、R2组(P＜0.05).结论 瑞芬太尼全凭静脉麻醉后以0.01～0.03 μg· kg-1·min-1速率持续静脉输注可减轻患者围拔管期心血管反应,对呼吸抑制作用较弱.     

Attenuation of cardiovascular response to laryngoscopy and tracheal intubation with bolus injection of diltiazem]

Effect of diltiazem on cardiovascular response to laryngoscopy and tracheal intubation was studied in 20 patients without hypertension and 10 patients with hypertension to be operated on under general anesthesia. The patients were divided into three groups: the first group without hypertension (group C, n = 10) received saline as control, the second group without hypertension (group N, n = 10) received bolus injection of diltiazem, and the third group with hypertension (group H, n = 10) received bolus injection of diltiazem. Diltiazem was administered 2 min before intubation at a dose of 0.2 mg.kg-1 as a bolus injection. Changes of mean blood pressure, rate pressure product, pressure rate quotient in group H and N decreased significantly compared with group C. Changes of heart rate were comparable among the three groups. Complications were not remarkable except one case in which systolic pressure decreased to 80 mmHg. The results suggest that bolus injection of diltiazem at a dose of 0.2 mg.kg-1 attenuates cardiovascular response to laryngoscopy and tracheal intubation without serious complications.     

Median effective concentration of remifentanil in target controlled infusion for smooth tracheal extubation during emergence from general anesthesia in elderly patients

Study objectiveTo determine the median effective concentration (EC₅₀) of remifentanil during targeted-controlled infusion for smooth tracheal extubation during emergence from total intravenous anesthesia in elderly patients.DesignProspective, Dixon up-and-down method.SettingPostoperative emergence.PatientsTwenty-four American Society of Anesthesiologists grade I-II female elderly patients undergoing elective jaw cyst surgery.InterventionsThe EC₅₀ of remifentanil for smooth emergence was calculated by the Dixon up-and-down method.MeasurementsThe EC₅₀ and 95% confidence intervals were analyzed by probit analysis using logistic regression. Vital signs (mean arterial pressure, heart rate, oxygen saturation, and end-tidal carbon dioxide partial pressure), postanesthesia recovery score, visual analogue pain scale, and adverse effects were monitored. Mean arterial pressure and heart rate were compared between patients with smooth extubation vs those with failed smooth extubation.Main resultsThe Dixon up-and-down method showed that the EC₅₀ of remifentanil for smooth tracheal extubation during emergency from anesthesia was 0.94 ng/mL in female elderly patients. The probit analysis showed that the EC₅₀ of remifentanil was 0.99 ng/mL (95% confidence interval, 0.52-1.51 ng/mL). Heart rate and mean arterial pressure were significantly lower in patients with smooth extubation as compared with those with failed smooth extubation at 0 minute (at extubation) as well as 1 and 5 minutes after extubation (P< .05).ConclusionsTarget infusion of remifentanil at 0.94 ng/mL could effectively inhibit tracheal extubation–related cough response and cardiovascular responses in 50% of the female elderly patients without delaying recovery from anesthesia, which could ensure smooth tracheal extubation during emergence from anesthesia.     

Seizures in a 77-year-old-woman after a bolus dose of remifentanil

Seizures in patients with no history of epilepsy has been associated with administration of remifentanil in two previous case reports. We present a case where a bolus dose of remifentanil (50 micrograms/kg) was followed by a self terminating generalised tonic-clonic seizure in a patient admitted for acute hip surgery, and no previous history of epilepsy.