复合舒芬太尼时瑞马唑仑抑制老年患者鼻咽通气道置入反应的半数有效剂量

Median effective dose of remimazolam combined with sufentanil for inhibition of nasopharyngeal airway insertion reaction in elderly patients

目的探讨复合舒芬太尼时瑞马唑仑抑制老年患者鼻咽通气道置入反应的半数有效剂量(ED_(50))。方法选择择期在鼻咽通气道下完成白内障手术的老年患者38例,年龄≥65岁,BMI 18~25 kg/m^(2),ASAⅠ—Ⅲ级。患者依次静脉注射舒芬太尼0.1μg/kg,3 min后静脉注射瑞马唑仑,2 min后置入鼻咽通气道。首例患者给予瑞马唑仑0.2 mg/kg,采用改良Dixon序贯法确定下一例患者瑞马唑仑的剂量,若前一例患者鼻咽通气道置入时出现以下任意一种阳性反应(摇头、呛咳、体动、HR增快幅度>基础值的20%、SBP或DBP升高幅度>基础值的20%),则下一例麻醉诱导时瑞马唑仑剂量增加0.01 mg/kg,反之则减少0.01 mg/kg,直到出现7次折返后停止。采用Probit回归分析计算复合舒芬太尼时瑞马唑仑抑制老年患者鼻咽通气道置入反应的ED_(50)、95%有效剂量(ED95)及95%可信区间(CI)。结果复合舒芬太尼时瑞马唑仑抑制鼻咽通气道置入反应的ED_(50)为0.193 mg/kg(95%CI 0.191~0.195 mg/kg),ED95为0.209 mg/kg(95%CI 0.205~0.213 mg/kg)。结论复合舒芬太尼时瑞马唑仑抑制老年患者鼻咽通气道置入反应的ED_(50)为0.193 mg/kg(95%CI 0.191~0.195 mg/kg)。

Objective To calculate median effective dose(ED_(50))of remimazolam combined with sufentanil for inhibition of nasopharyngeal airway insertion reaction in elderly patients.Methods Thirty⁃eight patients,aged≥65 years,BMI 18-25 kg/m^(2),ASA physical statusⅠ-Ⅲ,undergoing elective cata⁃ract surgery under nasopharyngeal airway were selected.Patients received intravenous sufentanil injections of 0.1μg/kg,followed by intravenous remimazolam injection 3 minutes later,then nasopharyngeal airway in⁃sertion after 2 minutes.The initial dose of remimazolam was 0.2 mg/kg and adjusted by 0.01 mg/kg,based on the modified Dixon sequential method.A positive reaction was defined as head shaking,choking,body movement,an increase in HR>20%of the basal value,or an increase in SBP or DBP>20%of the basal value at the time of nasopharyngeal airway placement.The procedure was stopped after seven crossovers.The ED_(50),95%effective dose(ED95)of remimazolam,and 95%confidence intervals(CI)were calculated by probabilistic unit(Probit)regression analysis.Results When combined with sufentanil,the ED_(50) and ED95 of remimazolam for inhibition of nasopharyngeal airway insertion in elderly patients was 0.193 mg/kg(95%CI 0.191-0.195 mg/kg)and 0.209 mg/kg(95%CI 0.205-0.213 mg/kg),respectively.Conclusion The ED_(50) of remimazolam combined with sufentanil for inhibition of nasopharyngeal airway in⁃sertion reaction in elderly patients were 0.193 mg/kg(95%CI 0.191-0.195 mg/kg).