国际麻醉学与复苏杂志   2024, Issue (5): 8-8
    
复合舒芬太尼时环泊酚抑制喉罩置入反应的量效关系
陈觅1()
1.贵州医科大学附属医院麻醉科
Dose‑effect relationship of ciprofol combined with sufentanil in inhibiting the response to laryngeal mask airway insertion
 全文:
摘要:

目的 探讨复合舒芬太尼时环泊酚抑制喉罩置入反应的量效关系。 方法 择期行喉罩置入全身麻醉手术患者23例,性别不限,年龄18~60岁,体重指数(BMI)18~30 kg/m2,美国麻醉医师协会(ASA)分级Ⅰ、Ⅱ级。麻醉诱导予静脉注射舒芬太尼0.3 μg/kg,5 min后静脉注射环泊酚,患者意识消失后静脉注射罗库溴铵0.6 mg/kg,3 min后置入喉罩。环泊酚剂量由序贯法确定,初始剂量为0.30 mg/kg,剂量梯度为0.05 mg/kg,根据是否发生喉罩置入反应确定下一例患者的环泊酚剂量。若喉罩置入时出现体动、口角动、呛咳、皱眉、流泪、喉痉挛等反应,或喉罩置入后3 min内的心率或血压升高幅度超过麻醉前基础值20%为阳性反应。若喉罩置入反应阳性或2 min内改良警觉/镇静评分量表(mOAA/S)评分仍>1分,则下一例患者的环泊酚上升一个剂量梯度,否则下降一个剂量梯度。记录患者进入手术室后(T1)、麻醉诱导后(T2)、喉罩置入后(T3)时的心率、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2),记录T2时0.20~0.30 mg/kg环泊酚注射后2 min内患者意识消失时间并计算患者意识消失成功率,记录麻醉诱导后不良反应(心动过缓、低血压、注射痛)发生情况等。采用Probit法计算环泊酚抑制喉罩置入反应的半数有效量(ED50)、95%有效量(ED95)和各自95%置信区间(CI)。 结果 与T1比较,T2、T3时心率、SBP、DBP、MAP降低(均P<0.05),SpO2升高(均P<0.05)。T2时,0.20~0.30 mg/kg环泊酚注射后2 min内意识消失成功患者的意识消失时间为(71.0±17.8) s。环泊酚0.15、0.20、0.25、0.30 mg/kg注射后2 min内意识消失成功率分别为0、40.0%、85.7%、100%。麻醉诱导后5例(21.7%)患者发生心动过缓,7例(30.4%)患者发生低血压,1例(4.35%)患者发生注射痛。复合舒芬太尼时环泊酚抑制喉罩置入反应的ED50及其95%CI为0.212(0.182~0.242) mg/kg、ED95及其95%CI为0.265(0.237~0.414) mg/kg。 结论 复合舒芬太尼时环泊酚抑制喉罩置入反应的ED50为0.212 mg/kg、ED95为0.265 mg/kg。

关键词: 环泊酚; 舒芬太尼; 喉罩; 剂量效应关系
Abstract:

Objective To investigate the dose‑effect relationship of ciprofol in inhibiting the response to laryngeal mask airway insertion when used in combination with sufentanil. Methods A total of 23 patients, men or women, aged 18−60 years, with body mass index (BMI) of 18−30 kg/m2, American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ, who underwent elective laryngeal mask airway insertion under general anesthesia were selected. Anesthesia induction was conducted through intravenous injection of sufentanil at 0.3 μg/kg, followed by intravenously injection ciprofol 5 min later. After the patients became unconscious, they were intravenously injected with 0.6 mg/kg of rocuronium, before laryngeal mask airway insertion 3 min later. The dose of ciprofol was determined by the up‑and‑down method, with an initial dose of 0.30 mg/kg and a dose gradient of 0.05 mg/kg. The next patient's ciprofol dose was determined according to the response to laryngeal mask airway insertion. The response was positive, when body movement, mouth movement, choking cough, frowning, tears, laryngeal spasm and other reactions occurred during laryngeal mask airway insertion, or the heart rate or blood pressure increased by 20% of pre‑anesthesia baseline within 3 min after laryngeal mask airway insertion. If the response to laryngeal mask airway insertion was positive, or the modified Observer's Assessment of Alertness/Sedation (mOAA/S) score was more than 1 point within 2 min, the dose of ciprofol would increase by one gradient in the next patient, or decrease by one gradient. Their heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse oxygen saturation (SpO2) were recorded after the patients entered the operation room (T1), after anesthesia induction (T2), and after laryngeal mask airway insertion (T3). The time to loss of consciousness within 2 min after injection of 0.20−0.30 mg/kg ciprofol at T2 was recorded and the success rate of loss of consciousness was calculated. The incidences of adverse reactions after anesthesia induction (bradycardia, hypotension, and injection pain) were recorded. The median effective dose (ED50) [95% confidence interval (CI)] and 95% effective dose (ED95) (95%CI) of ciprofol to inhibit the response to laryngeal mask airway insertion were calculated by the Probit method. Results Compared with those at T1, HR, SBP, DBP, and MAP decreased (all P<0.05), but SpO2 increased (all P<0.05) at T2 and T3. At T2, the time to loss of consciousness within 2 min after injection of 0.20−0.30 mg/kg ciprofol was (71.0±17.8) s. The success rate of loss of consciousness within 2 min after injection of 0.15, 0.20, 0.25 mg/kg and 0.30 mg/kg ciprofol was 0, 40.0%, 85.7%, and 100%, respectively. After anesthesia induction, bradycardia occurred in five patients (21.7%), hypotension in seven patients (30.4%), and injection pain in one patient (4.35%). When used in combined with sufentanil, the ED50 and 95%CI of ciprofol to inhibit the response to laryngeal mask airway insertion were 0.212 (0.182−0.242) mg/kg, and the ED95 and 95%CI were 0.265 (0.237−0.414) mg/kg. Conclusions The ED50 and ED95 of ciprofol when used in combination with sufentanil to inhibit the response to laryngeal mask airway insertion are 0.212 mg/kg and 0.265 mg/kg, respectively.

Key words: Ciprofol; Sufentanil; Laryngeal mask airway; Dose‑effect relationship