A prospective clinical trial predicting the 95% effective concentration of remifentanil for skull pin fixation using haemodynamic and surgical pleth index monitoring.

IF 1.9 Q1 ANESTHESIOLOGY
Indian Journal of Anaesthesia Pub Date : 2025-06-01 Epub Date: 2025-05-14 DOI:10.4103/ija.ija_911_24
Ying-Tzu Chen, Yueh-Ting Lai, Hou-Chuan Lai, Ann-Shung Lieu, Meei-Shyuan Lee, Zhi-Fu Wu
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引用次数: 0

Abstract

Background and aims: Inadequate antinociception during skull pin fixation can destabilise haemodynamics in patients undergoing intracranial surgery. However, the concentration of remifentanil required to achieve sufficient antinociception and maintain stable haemodynamics under surgical pleth index (SPI) monitoring remains unestablished. We aimed to determine the 95% effective concentration (EC95) of remifentanil for skull pin fixation using haemodynamic and SPI monitoring.

Methods: Nineteen patients undergoing intracranial surgery were enroled. Anaesthesia was administered via target-controlled infusion (TCI) of remifentanil and propofol and monitored using the SPI and bispectral index (BIS). Skull pin fixation was conducted at varying remifentanil effect-site concentrations, determined using Dixon's up-and-down method with a 0.5-ng/mL step size while maintaining a BIS of 40-60. Severe pain was defined as SPI >80, haemodynamic change >20% from baseline, heart rate (HR) >100 bpm, or blood pressure >180/100 mmHg and classified as a failure. Success was defined as SPI ≤80 and haemodynamic stability (haemodynamic changes < 20% from baseline, HR ≤100 bpm, and arterial blood pressure ≤180/100 mmHg occurring simultaneously). Statistical tests were conducted using SPSS Statistics (Version 27.0; IBM, Armonk, NY) for Windows.

Results: Probit analysis of seven pairs of failure-success outcomes revealed that the EC95 of remifentanil for skull pin fixation, providing adequate antinociception and haemodynamic stability, was 4.23 ng/mL.

Conclusion: Skull pin fixation can be performed in 95% of patients without triggering noxious stimulation-induced cardiovascular responses by setting remifentanil to 4.23 ng/mL, utilising remifentanil/propofol TCI with SPI and BIS monitoring.

一项前瞻性临床试验,通过血流动力学和手术体积指数监测预测瑞芬太尼用于颅骨钉固定的95%有效浓度。
背景和目的:颅内手术患者颅骨钉固定时抗痛觉作用不足会导致血流动力学不稳定。然而,在手术体积指数(SPI)监测下,实现足够的抗避孕和维持稳定的血流动力学所需的瑞芬太尼浓度仍未确定。我们的目的是通过血流动力学和SPI监测来确定瑞芬太尼用于颅骨钉固定的95%有效浓度(EC95)。方法:入选19例颅内手术患者。通过靶控输注瑞芬太尼和异丙酚进行麻醉,并使用SPI和双谱指数(BIS)进行监测。颅骨钉固定在不同的瑞芬太尼效应位点浓度下进行,采用Dixon的上下法测定,步长为0.5 ng/mL,同时保持BIS为40-60。重度疼痛定义为SPI bbb80,血流动力学变化>20%,心率>100bpm,或血压>180/ 100mmhg,并归类为衰竭。成功的定义是SPI≤80和血流动力学稳定(血流动力学变化比基线< 20%,HR≤100bpm,动脉血压≤180/ 100mmhg同时发生)。采用SPSS Statistics (Version 27.0;IBM, Armonk, NY)的Windows。结果:7对失败-成功结果的概率分析显示,瑞芬太尼用于颅骨钉固定的EC95为4.23 ng/mL,具有足够的抗刺痛和血流动力学稳定性。结论:将瑞芬太尼浓度设定为4.23 ng/mL,使用瑞芬太尼/异丙酚TCI并监测SPI和BIS, 95%的患者可在不引发有害刺激诱导的心血管反应的情况下进行颅骨钉固定。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.20
自引率
44.80%
发文量
210
审稿时长
36 weeks
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