O M Marges, J P Nieboer, I N de Keijzer, R Rettab, K van Amsterdam, T W L Scheeren, A R A Absalom, H E M Vereecke, M M R F Struys, J J Vos, J P van den Berg
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We hypothesize that a clinically significant difference in the incidence and severity of hypotension will be found when different doses of propofol and remifentanil are used for induction of anaesthesia.</p><p><strong>Methods: </strong>This is a secondary analysis of a randomised controlled trial wherein four groups (A-D) of patients received one out of four different combinations of propofol and remifentanil, titrated to a predicted equipotency in probability of tolerance to laryngoscopy (PTOL) according to the Bouillon interaction model. In group A, a high dose of propofol and a low dose of remifentanil was administered, and across the groups this ratio was gradually changed until it was reversed in group D. Mean and systolic arterial blood pressure (MAP, SAP) were compared at four time points (T<sub>baseline</sub>, T<sub>post-bolus</sub>, T<sub>3min</sub>, T<sub>nadir</sub>) within and between groups Heart rate, bispectral index (BIS) and the incidence of hypotension were compared.</p><p><strong>Results: </strong>Data from 76 patients was used. At T<sub>post-bolus</sub> a statistically significant lower MAP and SAP was found in group A versus D (p = 0.011 and p = 0.002). A significant higher heart rate was found at T<sub>3min</sub> and T<sub>nadir</sub> between groups A and B when compared to groups C and D (p = < 0.001 and p = 0.002). A significant difference in BIS value was found over all groups at T<sub>3min</sub> and T<sub>nadir</sub> (both p < 0.001). All other outcomes did not differ significantly between groups.</p><p><strong>Conclusion: </strong>Induction of anaesthesia with different predicted equipotent combinations of propofol and remifentanil did result in statistically different but clinically irrelevant differences in haemodynamic endpoints during induction of anaesthesia. Our study could not identify preferable drug combinations that decrease the risk for hypotension after induction, although they all yield a similar predicted PTOL.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1347-1355"},"PeriodicalIF":2.0000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604680/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparing the haemodynamic effects of high- and low-dose opioid anaesthesia: a secondary analysis of a randomised controlled trial.\",\"authors\":\"O M Marges, J P Nieboer, I N de Keijzer, R Rettab, K van Amsterdam, T W L Scheeren, A R A Absalom, H E M Vereecke, M M R F Struys, J J Vos, J P van den Berg\",\"doi\":\"10.1007/s10877-024-01195-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Post-induction hypotension (MAP < 65 mmHg) occurs frequently and is usually caused by the cardiovascular adverse effects of the anaesthetic induction drugs used. We hypothesize that a clinically significant difference in the incidence and severity of hypotension will be found when different doses of propofol and remifentanil are used for induction of anaesthesia.</p><p><strong>Methods: </strong>This is a secondary analysis of a randomised controlled trial wherein four groups (A-D) of patients received one out of four different combinations of propofol and remifentanil, titrated to a predicted equipotency in probability of tolerance to laryngoscopy (PTOL) according to the Bouillon interaction model. In group A, a high dose of propofol and a low dose of remifentanil was administered, and across the groups this ratio was gradually changed until it was reversed in group D. Mean and systolic arterial blood pressure (MAP, SAP) were compared at four time points (T<sub>baseline</sub>, T<sub>post-bolus</sub>, T<sub>3min</sub>, T<sub>nadir</sub>) within and between groups Heart rate, bispectral index (BIS) and the incidence of hypotension were compared.</p><p><strong>Results: </strong>Data from 76 patients was used. At T<sub>post-bolus</sub> a statistically significant lower MAP and SAP was found in group A versus D (p = 0.011 and p = 0.002). A significant higher heart rate was found at T<sub>3min</sub> and T<sub>nadir</sub> between groups A and B when compared to groups C and D (p = < 0.001 and p = 0.002). A significant difference in BIS value was found over all groups at T<sub>3min</sub> and T<sub>nadir</sub> (both p < 0.001). All other outcomes did not differ significantly between groups.</p><p><strong>Conclusion: </strong>Induction of anaesthesia with different predicted equipotent combinations of propofol and remifentanil did result in statistically different but clinically irrelevant differences in haemodynamic endpoints during induction of anaesthesia. 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引用次数: 0
摘要
诱导后低血压（MAP 方法：这是一项随机对照试验的二次分析，在该试验中，四组（A-D）患者分别接受了异丙酚和瑞芬太尼四种不同组合中的一种，并根据布永交互模型滴定至喉镜检查耐受概率（PTOL）的预测相等值。A 组使用高剂量的异丙酚和低剂量的瑞芬太尼，在各组中逐渐改变这一比例，直到 D 组发生逆转。比较组内和组间四个时间点（Tbaseline、Tpost-bolus、T3min、Tnadir）的平均和收缩动脉血压（MAP、SAP）：使用了 76 名患者的数据。与 D 组相比，A 组在 Tpost-bolus 时的 MAP 和 SAP 有显著统计学差异（p = 0.011 和 p = 0.002）。与 C 组和 D 组相比，A 组和 B 组在 T3min 和 Tnadir 时的心率明显较高（p = 3min 和 Tnadir（均为 p 结论：A 组和 B 组在 T3min 和 Tnadir 时的心率明显较高（p = 3min 和 Tnadir）：在麻醉诱导过程中，使用丙泊酚和瑞芬太尼的不同预测等效组合确实会导致血流动力学终点出现统计学上的差异，但在临床上并无相关性。我们的研究未能找出降低诱导后低血压风险的更佳药物组合，尽管它们都能产生相似的预测 PTOL。
Comparing the haemodynamic effects of high- and low-dose opioid anaesthesia: a secondary analysis of a randomised controlled trial.
Post-induction hypotension (MAP < 65 mmHg) occurs frequently and is usually caused by the cardiovascular adverse effects of the anaesthetic induction drugs used. We hypothesize that a clinically significant difference in the incidence and severity of hypotension will be found when different doses of propofol and remifentanil are used for induction of anaesthesia.
Methods: This is a secondary analysis of a randomised controlled trial wherein four groups (A-D) of patients received one out of four different combinations of propofol and remifentanil, titrated to a predicted equipotency in probability of tolerance to laryngoscopy (PTOL) according to the Bouillon interaction model. In group A, a high dose of propofol and a low dose of remifentanil was administered, and across the groups this ratio was gradually changed until it was reversed in group D. Mean and systolic arterial blood pressure (MAP, SAP) were compared at four time points (Tbaseline, Tpost-bolus, T3min, Tnadir) within and between groups Heart rate, bispectral index (BIS) and the incidence of hypotension were compared.
Results: Data from 76 patients was used. At Tpost-bolus a statistically significant lower MAP and SAP was found in group A versus D (p = 0.011 and p = 0.002). A significant higher heart rate was found at T3min and Tnadir between groups A and B when compared to groups C and D (p = < 0.001 and p = 0.002). A significant difference in BIS value was found over all groups at T3min and Tnadir (both p < 0.001). All other outcomes did not differ significantly between groups.
Conclusion: Induction of anaesthesia with different predicted equipotent combinations of propofol and remifentanil did result in statistically different but clinically irrelevant differences in haemodynamic endpoints during induction of anaesthesia. Our study could not identify preferable drug combinations that decrease the risk for hypotension after induction, although they all yield a similar predicted PTOL.
期刊介绍：
The Journal of Clinical Monitoring and Computing is a clinical journal publishing papers related to technology in the fields of anaesthesia, intensive care medicine, emergency medicine, and peri-operative medicine.
The journal has links with numerous specialist societies, including editorial board representatives from the European Society for Computing and Technology in Anaesthesia and Intensive Care (ESCTAIC), the Society for Technology in Anesthesia (STA), the Society for Complex Acute Illness (SCAI) and the NAVAt (NAVigating towards your Anaestheisa Targets) group.
The journal publishes original papers, narrative and systematic reviews, technological notes, letters to the editor, editorial or commentary papers, and policy statements or guidelines from national or international societies. The journal encourages debate on published papers and technology, including letters commenting on previous publications or technological concerns. The journal occasionally publishes special issues with technological or clinical themes, or reports and abstracts from scientificmeetings. Special issues proposals should be sent to the Editor-in-Chief. Specific details of types of papers, and the clinical and technological content of papers considered within scope can be found in instructions for authors.
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