复合丙泊酚时阿芬太尼抑制儿童喉罩置入反应的半数有效剂量

Median effective dose of alfentanil combined with propofol inhibiting responses to laryngeal mask airway insertion in children

目的确定复合丙泊酚时阿芬太尼抑制儿童喉罩置入反应的半数有效剂量(ED_(50))。方法拟行面部皮肤色素痣切除整形术患儿,ASA分级Ⅰ级,年龄6~10岁,BMI 18~24 kg/m^(2)。所有患儿靶控输注丙泊酚(血浆靶浓度3μg/ml),静脉注射阿芬太尼,2 min后置入喉罩,2%~3%七氟烷维持麻醉完成手术。采用序贯法进行研究,阿芬太尼初始剂量为15μg/kg,若喉罩置入反应阳性,下一例患儿阿芬太尼剂量增加1μg/kg,若喉罩置入反应阴性,则下一例患儿阿芬太尼剂量减少1μg/kg。喉罩置入反应:喉罩置入时发生吞咽、呛咳、体动反应,重复此过程直到出现7个拐点。采用probit法计算复合丙泊酚时阿芬太尼抑制儿童喉罩置入反应的ED_(50)及其95%可信区间。结果复合丙泊酚时阿芬太尼抑制儿童喉罩置入反应的ED_(50)及其95%可信区间为13.18(12.43~13.79)μg/kg。结论复合丙泊酚时阿芬太尼抑制儿童喉罩置入反应的ED_(50)为13.18μg/kg。

Objective To determine the median effective dose(ED_(50))of alfentanil combined with propofol inhibiting responses to the laryngeal mask airway(LMA)insertion in children.Methods American Society of Anesthesiologists Physical Status classificationⅠchildren,aged 6-10 yr,with body mass index of 18-24 kg/m^(2),undergoing facial skin pigmented nevus resection,were selected.Propofol(target plasma concentration 3μg/ml)was given by the target-controlled infusion,alfentanil was intravenously injected,2 min later LMA was inserted,and anesthesia was maintained with 2%-3%sevoflurane until the end of surgery.The dose of alfentanil was determined by the up-and-down sequential method,the initial dose of alfentanil was 15μg/kg,when the response to LMA insertion was positive/negative,the dose of alfentanil increased/decreased by 1μg/kg in the next case.The LMA insertion response was defined as swallowing,bucking,body movement occurred during insertion of the LMA,and this process was repeated until 7th turning points appeared.The ED_(50) and 95%confidence interval of alfentanil combined with propofol inhibiting responses to LMA insertion in children were calculated using probit method.Results The ED_(50) of alfentanil combined with propofol inhibiting responses to LMA insertion was 13.18(95%confidence interval 12.43-13.79)μg/kg in children.Conclusions The ED_(50) of alfentanil combined with propofol inhibiting responses to LMA insertion is 13.18μg/kg in children.