Remifentanil versus remifentanil/midazolam for ambulatory surgery during monitored anesthesia care

被引:50
作者
Gold, MI
Watkins, WD
Sung, YF
Yarmush, J
Chung, F
Uy, NT
Maurer, W
Clarke, MY
Jamerson, BD
机构
[1] Department of Anesthesiology, University of Miami, Miami, FL
[2] Department of Anesthesiology, Univ. of Pittsburgh Medical Center, Pittsburgh, PA
[3] Department of Anesthesiology, The Emory Clinic, Atlanta, GA
[4] Department of Anesthesiology, UMD New Jersey Medical School, Newark, NJ
[5] Department of Anaesthaesiology, Toronto Hospital, Toronto, Ont.
[6] Department of Anesthesiology, Magee-Womens Hospital, Pittsburgh, PA
[7] Department of Anesthesiology, Cleveland Clinic Foundation, Cleveland, OH
[8] Glaxo Wellcome Inc., Research Triangle Park, NC
[9] University of Miami, Anesthesia Service 139, Vet. Administration Medical Center, Miami, FL 33125
关键词
anesthetics; intravenous; remifentanil; midazolam; analgesics; opioids; anesthesia adjuvants; ambulatory care; anesthesia recovery period; aesthetic; local;
D O I
10.1097/00000542-199707000-00007
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background. This study was designed to define the appropriate dose of remifentanil hydrochloride alone or combined with midazolam to provide satisfactory comfort and maintain adequate respiration for a monitored anesthesia care setting. Methods: One hundred fifty-nine patients scheduled for outpatient surgery participated in this multicenter, double-blind study. Patients were randomly assigned to one of two groups: remifentanil, 1 mu g/kg, given over 30 s followed by a continuous infusion of 0.1 mu g.kg(-1).min(-1) (remifentanil); remifentanil, 0.5 mu g/kg, given over 30 s followed by a continuous infusion of 0.05 mu g.kg(-1).min(-1) (remifentanil + midazolam). Five minutes after the start of the infusion, patients received a loading dose of saline placebo (remifentanil) or midazolam, 1 mg, (remifentanil + midazolam). If patients were not oversedated, a second dose of placebo or midazolam, 1 mg, was given. Remifentanil was titrated (in increments of 50% from the initial rate) to limit patient discomfort or pain intraoperatively, and the infusion was terminated at the completion of skin closure. Results: At the time of the local anesthetic, most patients in the remifentanil and remifentanil + midazolam groups experienced no pain (66% and 60%, respectively) and no discomfort (66% and 65%, respectively). The final mean (+/- SD) remifentanil infusion rates were 0.12 +/- 0.05 mu g.kg(-1).min(-1) (remifentanil) and 0.07 +/- 0.03 mu g.kg(-1).min(-1) (remifentanil + midazolam). Fewer patients in the remifentanil + midazolam group experienced nausea compared with the remifentanil group (16% vs. 36%, respectively; P < 0.05). Four patients (5%) in the remifentanil group and two patients (2%) in the remifentanil + midazolam group experienced brief periods of oxygen desaturation (Sp(O2) < 90%) and hypoventilation (< 8 breaths/ min). Conclusions: Remifentanil alone or combined with midazolam provided adequate analgesia and maintained adequate respiration at the doses reported. The low dose of remifentanil combined with 2 mg midazolam, compared with remifentanil alone, resulted in fewer side effects, slightly greater sedation, and less anxiety.
引用
收藏
页码:51 / 57
页数:7
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