利多卡因超声雾化气道表面麻醉无肌松插管瑞芬太尼半数有效浓度

Effect-site concentration of remifentanil for tracheal intubation under trachea topical anesthesia with ultrasonic atomized lidocaine

目的确定经超声雾化吸入2%利多卡因气道表面麻醉无肌松条件下靶控输注(TCI)瑞芬太尼抑制气管插管反应的半数有效浓度(Ce50)。方法择期乳腺癌全麻女性患者32例,年龄24～59岁。2%利多卡因超声雾化吸入后,丙泊酚2～3mg/kg分次推注继以6～8mg·kg-1·h-1恒速泵注,维持BIS40～60。使用Dixon序贯法确定瑞芬太尼效应室靶浓度,初始靶浓度3.5ng/ml,平衡10min后行气管插管,靶浓度梯度0.5ng/ml。采用概率回归分析法计算瑞芬太尼抑制插管反应的Ce50及其95%可信区间(CI)。结果有1例患者因严重心动过缓而排除。瑞芬太尼抑制插管反应的Ce50为3.48ng/ml,95%CI为2.22～4.97ng/ml。结论利多卡因超声雾化气道表面麻醉无肌松插管TCI瑞芬太尼Ce50为3.48ng/ml。

Objective To determine the median effect concentration （Ces0） of remifentanil for tracheal intubation under trachea topical anesthesia with ultrasonic atomized lidocaine without the muscle relaxant. Methods Thirty-two female patients aged 24-59 years scheduled for radical operation of mastocarcinoma under general anesthesia were enrolled. The trachea topical anesthesia with 2~ lidocaine 10 ml was inhaled after ultrasonic atomization, and then anesthesia was induced with 2-3 mg/kg of propofol and then maintained with 6-8 mg.kg-1 ＂h-1 of propofol to keep the value of BIS at 40-60. The Dixon＇s up-and-down sequential experiment was used after setting the initial concentration （Ce） at 3. 5 ng/ml, and the changing unit of remifentanil was 0. 5 ng/ml for each time until the tracheal intubation was placed 10 min later. The Ces0 of remifentanil and 95 % confidence interval （CI） were calculated. Results One patient was excluded for severe bradyarrhythmia. The Ces0 of remifentanil for tracheal intubation without muscle relaxant when combined with trachea topical ultrasonic atomized 2% lidocaine was 3.48 ng/ml and the 95o/60 CI was 2.22-4.97 ng/ml. Conclusion The Ces0 for remifentanil under trachea topical anesthesia with ultrasonic atomized 2% lidocaine was 3.48 ng/ml.