老年患者靶控输注丙泊酚和瑞芬太尼的临床研究
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摘要
目的
随着国际老龄化趋势的日渐明显,老年手术患者成为一个重要的特殊麻醉群体,但尚缺乏在不同年龄段的老年患者靶控输注丙泊酚和瑞芬太尼时如何选取合适靶浓度的详细资料。本研究旨在探求国人60～69岁和70～79岁年龄段老年患者靶控输注丙泊酚意识消失的半数有效血浆浓度(EC_(P50)),以及联合丙泊酚靶控输注瑞芬太尼抑制插管反应和切皮刺激的半数有效血浆浓度(EC_(R50)),为临床麻醉提供参考。
方法
选取151例60～79岁, ASAⅠ-Ⅲ级,需在全麻气管插管下行择期手术的老年患者为研究对象,依年龄分为两组:Ⅰ组60～69岁,Ⅱ组70～79岁。第一部分共40例病人,采用Dixon改良序贯法测定EC_(P50)。两组第一例病人丙泊酚血浆靶浓度设为2.5μg/ml,第一步浓度梯度为0.5μg/ml,出现≥3个阴阳反应的交替波形后,第二步浓度梯度减小为0.2μg/ml,直到再次出现≥6个阴阳反应的交替波形。通过计算两组第二步各阴阳反应交替中点的均值来获得EC_(P50)。第二部分共111例病人,依据接受刺激(插管或切皮)的不同进一步分为四组:Ⅰ-TI组(60～69岁插管组)30例,Ⅱ-TI组(70～79岁插管组)30例,Ⅰ-SI组(60～69岁切皮组)26例,Ⅱ-SI组(70～79岁切皮组)25例。与第一部分同样采用Dixon改良序贯法测定各组的EC_(R50),第一步浓度梯度为0.5ng/ml,第二步浓度梯度减小为0.2 ng/ml。丙泊酚血浆靶浓度初步设为第一部分所测得的EC_(P50),进一步调节浓度达到BIS在50～60之间。TI组第一例病人和SI组所有病人瑞芬太尼血浆靶浓度均设为3.5 ng/ml,SI组病人在插管后即将瑞芬太尼浓度下调至预设浓度,SI组第一例病人瑞芬太尼血浆靶浓度设为2.5ng/ml,此后病人瑞芬太尼浓度依据上一例病人的反应而增减。计算方法同第一部分,可分别获得Ⅰ-TI组、Ⅱ-TI组、Ⅰ-SI组、Ⅱ-SI组的EC_(R50)。
结果
国人60～69岁年龄段老年患者意识消失时EC_(P50)为2.22μg/ml,在丙泊酚输注,BIS稳定在50～60时,抑制TI和SI的EC_(R50)分别为2.90ng/ml和1.90ng/ml;70～79岁年龄段老年患者意识消失EC_(P50)为1.81μg/ml,比Ⅰ组明显降低(P<0.05) ,抑制TI和SI的EC_(R50)分别为3.16ng/ml和1.77ng/ml,与Ⅰ组相比无统计学差异(P>0.05)。
结论
不同年龄段的老年患者靶控输注丙泊酚和瑞芬太尼时靶浓度的选择应注意个体化,精细化。在60～79岁年龄段的老年患者,随着年龄的增加,EC_(P50)逐渐降低;在联合丙泊酚靶控输注抑制TI和SI时,瑞芬太尼血浆靶浓度应根据患者的具体情况作调整,注意对循环系统的影响。对于高龄和危重症病人丙泊酚和瑞芬太尼靶浓度的选取还有待于进一步研究。
Obsjective
The elderly patients have been an important and special group with population aging in the world. However, there are not detailed information about a proper target concentration of propofol and remifentanil in the elderly patients in different age. We try to determine the effective plasma concentration of propofol(EC_(P50)) by TCI for loss of consciousness(LOC) in 50% of elderly patients aged 60～69yr and 70～79yr, and the effective plasma concentration of reminfentanil(EC_(R50)) by TCI combining propofol to prevent response to tracheal intubation(TI) and skin incision(SI) in 50% of elderly patients of that population, wish to provide some information for clinical anesthesia.
Methods
We recruited 151 ASAⅠ-Ⅲpatients aged 60～79yr, scheduled for elective surgery requiring tracheal intubation. They were divided into two groups according to their age: groupⅠ(60～69yr) and groupⅡ(70～79yr). In the first part of the study enrolling 40 patients, EC_(P50) were determined with a modified Dixon’s up-and-down method in two stages. The test space in the first stage was 0.5μg/ml,and the first patient in each group received an initial plasma concentration of propofol of 2.5μg/ml. After 3 or more negative-positive up-and-down crossovers, the initial test space was reduced to 0.2μg/ml. There were 6 or more negative-positive up-and-down crossovers in the second stage. EC_(P50) were obtained by calculating the mean values for crossover midpoints in the second stage of each group. 111 patients in the second part of the study were divided into four groups according to receiving different stimuli (TI or SI):30 in groupⅠ-TI(TI of 60～69yr) , 30 in groupⅡ-TI(TI of 70～79yr), 26 in groupⅠ-SI(SI of 60～69yr) and 25 in groupⅡ-SI(SI of 70～79yr). Same to the first part, EC_(R50) were determined with a modified Dixon’s up-and-down method. The initial test space in the first stage was 0.5 ng/ml,and was reduced to 0.2 ng/ml in the second stage. The target plasma concentration of propofol was EC_(P50) from the first part, and it might be adjusted with BIS value between 50 and 60. The first patient in group TI and all patients in group SI received an initial plasma concentration of reminfentanil of 3.5 ng/ml. After TI, the plasma concentration of reminfentanil in group SI was set at the designed concentration according to the up-and-down sequence, and the first patient in group SI received an plasma concentration of reminfentanil of 2.5 ng/ml. Then EC_(R50) in groupⅠ-TI,Ⅱ-TI,Ⅰ-SI andⅡ-SI were calculated as the first part.
Results
To patients aged 60～69yr, EC_(P50) was 2.22μg/ml,and combining propofol with BIS value between 50 and 60,EC_(R50) of group TI and group SI were 2.90ng/ml and 1.90ng/ml respectively. To patients aged 70～79yr, EC_(P50) was 1.81μg/ml,decreasing compared with groupⅠ(P<0.05) , and EC_(R50) of group TI and group SI were 3.16ng/ml and 1.77ng/ml respectively, similar to groupⅠ(P>0.05).
Conclusion
The elderly patients in different age should be administered an accurate plasma concentration of propofol and remifentanil individually by TCI. To patients aged 60～79yr, EC_(P50) descends with aging, and the plasma concentration of remifentanil combining propofol to prevent response to TI and SI could be adjusted according to status of individual patient, and influence on hemodynamics should be cautioned. Further studies are needed to seek proper concentration of propofol and remifentanil in patients of advanced age and with critical cardiovascular or pulmonary disease.
随着国际老龄化趋势的日渐明显,老年手术患者成为一个重要的特殊麻醉群体,但尚缺乏在不同年龄段的老年患者靶控输注丙泊酚和瑞芬太尼时如何选取合适靶浓度的详细资料。本研究旨在探求国人60～69岁和70～79岁年龄段老年患者靶控输注丙泊酚意识消失的半数有效血浆浓度(EC_(P50)),以及联合丙泊酚靶控输注瑞芬太尼抑制插管反应和切皮刺激的半数有效血浆浓度(EC_(R50)),为临床麻醉提供参考。
方法
选取151例60～79岁, ASAⅠ-Ⅲ级,需在全麻气管插管下行择期手术的老年患者为研究对象,依年龄分为两组:Ⅰ组60～69岁,Ⅱ组70～79岁。第一部分共40例病人,采用Dixon改良序贯法测定EC_(P50)。两组第一例病人丙泊酚血浆靶浓度设为2.5μg/ml,第一步浓度梯度为0.5μg/ml,出现≥3个阴阳反应的交替波形后,第二步浓度梯度减小为0.2μg/ml,直到再次出现≥6个阴阳反应的交替波形。通过计算两组第二步各阴阳反应交替中点的均值来获得EC_(P50)。第二部分共111例病人,依据接受刺激(插管或切皮)的不同进一步分为四组:Ⅰ-TI组(60～69岁插管组)30例,Ⅱ-TI组(70～79岁插管组)30例,Ⅰ-SI组(60～69岁切皮组)26例,Ⅱ-SI组(70～79岁切皮组)25例。与第一部分同样采用Dixon改良序贯法测定各组的EC_(R50),第一步浓度梯度为0.5ng/ml,第二步浓度梯度减小为0.2 ng/ml。丙泊酚血浆靶浓度初步设为第一部分所测得的EC_(P50),进一步调节浓度达到BIS在50～60之间。TI组第一例病人和SI组所有病人瑞芬太尼血浆靶浓度均设为3.5 ng/ml,SI组病人在插管后即将瑞芬太尼浓度下调至预设浓度,SI组第一例病人瑞芬太尼血浆靶浓度设为2.5ng/ml,此后病人瑞芬太尼浓度依据上一例病人的反应而增减。计算方法同第一部分,可分别获得Ⅰ-TI组、Ⅱ-TI组、Ⅰ-SI组、Ⅱ-SI组的EC_(R50)。
结果
国人60～69岁年龄段老年患者意识消失时EC_(P50)为2.22μg/ml,在丙泊酚输注,BIS稳定在50～60时,抑制TI和SI的EC_(R50)分别为2.90ng/ml和1.90ng/ml;70～79岁年龄段老年患者意识消失EC_(P50)为1.81μg/ml,比Ⅰ组明显降低(P<0.05) ,抑制TI和SI的EC_(R50)分别为3.16ng/ml和1.77ng/ml,与Ⅰ组相比无统计学差异(P>0.05)。
结论
不同年龄段的老年患者靶控输注丙泊酚和瑞芬太尼时靶浓度的选择应注意个体化,精细化。在60～79岁年龄段的老年患者,随着年龄的增加,EC_(P50)逐渐降低;在联合丙泊酚靶控输注抑制TI和SI时,瑞芬太尼血浆靶浓度应根据患者的具体情况作调整,注意对循环系统的影响。对于高龄和危重症病人丙泊酚和瑞芬太尼靶浓度的选取还有待于进一步研究。
Obsjective
The elderly patients have been an important and special group with population aging in the world. However, there are not detailed information about a proper target concentration of propofol and remifentanil in the elderly patients in different age. We try to determine the effective plasma concentration of propofol(EC_(P50)) by TCI for loss of consciousness(LOC) in 50% of elderly patients aged 60～69yr and 70～79yr, and the effective plasma concentration of reminfentanil(EC_(R50)) by TCI combining propofol to prevent response to tracheal intubation(TI) and skin incision(SI) in 50% of elderly patients of that population, wish to provide some information for clinical anesthesia.
Methods
We recruited 151 ASAⅠ-Ⅲpatients aged 60～79yr, scheduled for elective surgery requiring tracheal intubation. They were divided into two groups according to their age: groupⅠ(60～69yr) and groupⅡ(70～79yr). In the first part of the study enrolling 40 patients, EC_(P50) were determined with a modified Dixon’s up-and-down method in two stages. The test space in the first stage was 0.5μg/ml,and the first patient in each group received an initial plasma concentration of propofol of 2.5μg/ml. After 3 or more negative-positive up-and-down crossovers, the initial test space was reduced to 0.2μg/ml. There were 6 or more negative-positive up-and-down crossovers in the second stage. EC_(P50) were obtained by calculating the mean values for crossover midpoints in the second stage of each group. 111 patients in the second part of the study were divided into four groups according to receiving different stimuli (TI or SI):30 in groupⅠ-TI(TI of 60～69yr) , 30 in groupⅡ-TI(TI of 70～79yr), 26 in groupⅠ-SI(SI of 60～69yr) and 25 in groupⅡ-SI(SI of 70～79yr). Same to the first part, EC_(R50) were determined with a modified Dixon’s up-and-down method. The initial test space in the first stage was 0.5 ng/ml,and was reduced to 0.2 ng/ml in the second stage. The target plasma concentration of propofol was EC_(P50) from the first part, and it might be adjusted with BIS value between 50 and 60. The first patient in group TI and all patients in group SI received an initial plasma concentration of reminfentanil of 3.5 ng/ml. After TI, the plasma concentration of reminfentanil in group SI was set at the designed concentration according to the up-and-down sequence, and the first patient in group SI received an plasma concentration of reminfentanil of 2.5 ng/ml. Then EC_(R50) in groupⅠ-TI,Ⅱ-TI,Ⅰ-SI andⅡ-SI were calculated as the first part.
Results
To patients aged 60～69yr, EC_(P50) was 2.22μg/ml,and combining propofol with BIS value between 50 and 60,EC_(R50) of group TI and group SI were 2.90ng/ml and 1.90ng/ml respectively. To patients aged 70～79yr, EC_(P50) was 1.81μg/ml,decreasing compared with groupⅠ(P<0.05) , and EC_(R50) of group TI and group SI were 3.16ng/ml and 1.77ng/ml respectively, similar to groupⅠ(P>0.05).
Conclusion
The elderly patients in different age should be administered an accurate plasma concentration of propofol and remifentanil individually by TCI. To patients aged 60～79yr, EC_(P50) descends with aging, and the plasma concentration of remifentanil combining propofol to prevent response to TI and SI could be adjusted according to status of individual patient, and influence on hemodynamics should be cautioned. Further studies are needed to seek proper concentration of propofol and remifentanil in patients of advanced age and with critical cardiovascular or pulmonary disease.
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49. 李天儿,郭建荣. 不同靶控浓度异丙酚对老年患者脑电双频指数的影响.现代适用医学,2005,17(11):721-722.
50. De CastroV,Godet G,Mencia G,et al.Target-controlled infusion for remifentanil in vascular patients improves hemodynamics and decreases remifentanil requirement. Anesth Analg,2003,96:33-38.
51. Irwin MG, Hui TWC, Milne SE, et al. Propofol effective concentration 50 and its relationship to bispectral index. Anaesthesia, 2002, 57:242-248.
52. Glass P , Bloom M , Kearse L , et al. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology, 1997,86: 836-847.
53. Kazamz T,Lkeda K,et al. Comparion of the effect-site keos of propofok for blood pressure and EEG in elderly and younger patients. Anesthesiology, 1999, 90:1517 - 1527.
54. Schultz A, Grouven U, Zander I, et al. Age-related effects in the EEG during propofol anaesthesia. Acta Anaesthesiol Scand, 2004,48:27-34.
55. Roy RC. What’s new in geriatric anesthesia? 56thAnnual refresher course lectures and basic science reviews.2006,106: 1-7.
56. Guignard B, Menigaux C, Dupont X, et al. The effect of remifentanil on the bispectral index change and hemodynamic responsed after orotracheal intubation. Anesth Analg,2000,90:161-169.
57. Minto CF, Schnider TW, Egan TD, et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil.Ⅰ .Model development. Anesthesiology, 1997,86:10-23.
58. Minto CF, Schnider TW, Shafer SL. pharmacokinetics and pharmacodynamics of remifentanil.Ⅱ . Model application. Anesthesiology, 1997,86:24-33.
1. Rosow CE. An overview of remifentnil .Anesth Analg ,1999,89(Suppl):S1-3.
2. Minto CF, Schnider TW, Egan TD,et al. Influnence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil: I. Model development. Anesthesiology,1997,86:10-23.
3. Westmoreland CL, Hoke JF, Sebel PS, et al.Pharmacokinetics of remifentanil (GI87084B) and its major metabolite (GI90291) in patients undergoing elective inpatient surgery. Anesthesiology, 1993, 79:893-903.
4. Scott JC, Stanski DR. Decreased fentanyl and alfentanil dose requirements with age. A simultaneous pharmacokinetic and pharmacodynamic evaluation. J Pharmacol Exp Ther ,1987,240:159-166.
5. Lemmens HJ, Bovill JG, Hennis PJ,et al. Age has no effect on the pharmacodynamics of alfentanil. Anesth Analg ,1988,67:956-960.
6. Ausems ME, Hug CC, Stanski DR, et al. Plasma concentrations of alfentanil required to supplement nitrous oxide anesthesia for general surgery. Anesthesiology ,1986, 65:362-373.
7. Glass PSA, Gan TJ, Howell S. A review of the pharmacokinetics and pharmacodynamics of remifentanil. Anesth Analg ,1999,89(Suppl):S7-14.
8. 张卫,李治松,张斯,等. 异丙酚对老年患者瑞芬太尼靶控输注系统效能的影响. 中华麻醉学杂志,2006,26(3):207-210.
9. Merten MJ, Engbers FH, Burm AG, et al. Predictive performance of computer –controlled infusion of remifentanil during propofol/remifentanil anaesthesia. Br J Anaesth, 2003,90:132-141.
10. Hoymork SC, Reder J, Grmsmo B, et al. Bispectral index, predicted and measured drug level of target controlled infusion of remifentanil and propofol during laparoscopic cholecystectomy and emergenced. Acta Anaesth Scand, 2000, 44: 1138-1144.
11. Habib AS, Parker JL, Maguire AM, et al. Effects of remifentanil and alfentanil on thecardiovascular responses to induction of anesthesia and tracheal intubation in the elderly. Br J Anaesth, 2002,88(3):430-433.
12. 张卫,王中玉,庆淑梅,等. 不同速率输注瑞芬太尼对老年患者气管插管反应的影响. 中华麻醉学杂志,2006,26(2):114-117.
13. Maguire AM, Kumar N, Parker JL, et al. Comparison of effects of remifentanil and alfentanil on cardiovascular response to tracheal intubation in hypertensive patients. Br J Anaesth, 2001, 86(1): 90-93.
14. Myre K, Raeder J, Rostrup M, et al. Catecholamine release during laparoscopic fundoplication with high and low doses of remifentanil. Acta Anaesthsiol Scand, 2003,47: 267-273.
15. Jellish WS , Sheikh T , Baker WH , et al . Hemodynamic stability , myocardial ischemia , and perioperative outcome after carotid surgery with remifentanil/ propofol or isoflurane/ fentany1 anesthesia . J Neurosurg Anesthesiol , 2003 , 15 (3) :176 - 184.
16. Bekker A, Berklayd P, Osborn I , et al. The recovery of cognitive function after remifentanil -nitrous oxide anesthesia is faster than after an isoflurane-nitrous oxide-fentanyl combination in elderly patients. Anesth Analg2000; 91:117-122.
17. Kostopanagiotou G, Markantonis SL, Polydorou M,et al. Rocoveruy and cognitive function after fentanyl or remifentanil administration for caroid endarterectomy. J clin Anaesth,2005,17(1): 16-20.
18. 许川雅,吴新民,蒋建渝. 老年患者靶控输注瑞芬太尼和丙泊酚的临床评价.北京大学学报(医学版),2005,37(5):513-515.
19. Gardellin M, Durand M, Maitrasse B, et al. Continuous infusion of remifentanil and target –controlled infusion of propofol for coronary surgery in elderly patients : comparison with continuous infusion of remifentanil and propofol. Annales fran?aise d’ anesthésia et de réanimation, 2004, 23(10): 966-972.
20. Muravchick S. The elderly outpatient : current anesthetic implicatios. Curr Opin Anesthesiol, 2002, 15: 621-625.
21. Moller JT, The ISOPCD investigators. Long-term postoperative cognitive dysfunction in the elderly; ISPOCD1 study. Lancet ,1998, 351: 857-861.
22. Johnson T, Monk T, Rasmussen LS, et al. Postoperative cognitive dysfunction in middle-aged patients. Anesthesiology ,2002, 96: 1351-1357.
23. Guy J , Hindman BJ , Baker KZ , et al . Comparison of remifentanil and fentanyl in patients undergoing craniotomy for supratentorial space-occupying lesion. Anesthesiology, 1997 , 86 : 514-524.
24. Sneyd JR , Whaley A , Dimpel HL , et al . An open , randomized comparison of alfentanil , remifentanil and alfentanil followed by remifentanil in anesthesia for craniotomy. Br J Anaesth 1998; 81:361-364.
25. Larsen B , Seitz A , Larsen R . Recovery of cognitive function after remifentanil- propofol anesthesia: a comparison with desflurane and sevoflurane anesthesia. Anesth Analg,2000,90(1): 168-174.
26. Wilhelm W , Schlaich N , Harrer J, et al.Recovery and nerurological examination after remifentanil-desflurane and fentanyl-desflurane anesthesia for carolid artery surfery . Br J Anaesth, 2001,86(1):44-49.
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14. 许川雅,吴新民,蒋建渝. 老年患者靶控输注瑞芬太尼和丙泊酚的临床评价.北京大学学报(医学版),2005,37(5):513-515.
15. Gardellin M, Durand M, Maitrasse B, et al. Continuous infusion of remifentanil and target –controlled infusion of propofol for coronary surgery in elderly patients : comparison with continuous infusion of remifentanil and propofol. Annales fran?aise d’ anesthésia et de réanimation, 2004, 23(10): 966-972.
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38. Habib AS, Parker JL, Maguire AM, et al. Effects of remifentanil and alfentanil on the cardiovascular responses to induction of anesthesia and tracheal intubation in the elderly. Br J Anaesth, 2002,88(3):430-433.
39. 杨玲,刘保江,曹定睿. 病人靶控输注瑞芬太尼气管插管的可行性. 中华麻醉学杂志,2006,26(4):381-382.
40. Davis PJ,Finkel JC,Orr RJ,et al. A randomized double-blinded study of remifenanil versus fentanyl for tonsillectomy and adenoidectomy surgery in pediatric ambulatory surgical patients. Anesth Analg,2000,90:863-871.
41. Maguire AM, Kumar N, Parker JL, et al. Comparison of effects of remifentanil and alfentanil on cardiovascular response to tracheal intubation in hypertensive patients. Br J Anaesth, 2001, 86(1): 90-93.
42. 张熙哲,吴新民.异丙酚靶控输注时瑞芬太尼抑制气管插管反应的半数有效浓度. 中华麻醉学杂志,2006,26(3):204-206.
43. Heiko R, Michael KB,Monju C,et al. Propofol and remifentanil pharmacodynamic interaction during orthopedic surgical procedures as measured by effects on bispectral index. J Clin Anesth, 2001,13:198 -207.
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45. 易杰,郝绒绒,罗爱伦,等. 无肌松药下瑞芬太尼复合异丙酚靶控输注诱导病人气管插管的可行性. 中华麻醉学杂志,2006,26(4):293-295.
46. Mu?oz HR, Cortínez LI, Ibacache ME, et al. Remifentanil requirements during administration to block the somatic incision in children and adults. Anesth Analg 2007;104:77–80
47. Mu?oz HR, Cortínez LI, Altermatt FR,et al. Remifentanil requirements during sevoflurane administration to blocksomatic and cardiovascular responses to skin incision in children and adults. Anesthesiology 2002;97:1142–1145.
48. 关雷,李群,王军. 靶控输注法对丙泊酚复合不同浓度芬太尼的临床观察. 中国临床药理学杂志,2004,20(4):253-256.
49. 李天儿,郭建荣. 不同靶控浓度异丙酚对老年患者脑电双频指数的影响.现代适用医学,2005,17(11):721-722.
50. De CastroV,Godet G,Mencia G,et al.Target-controlled infusion for remifentanil in vascular patients improves hemodynamics and decreases remifentanil requirement. Anesth Analg,2003,96:33-38.
51. Irwin MG, Hui TWC, Milne SE, et al. Propofol effective concentration 50 and its relationship to bispectral index. Anaesthesia, 2002, 57:242-248.
52. Glass P , Bloom M , Kearse L , et al. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology, 1997,86: 836-847.
53. Kazamz T,Lkeda K,et al. Comparion of the effect-site keos of propofok for blood pressure and EEG in elderly and younger patients. Anesthesiology, 1999, 90:1517 - 1527.
54. Schultz A, Grouven U, Zander I, et al. Age-related effects in the EEG during propofol anaesthesia. Acta Anaesthesiol Scand, 2004,48:27-34.
55. Roy RC. What’s new in geriatric anesthesia? 56thAnnual refresher course lectures and basic science reviews.2006,106: 1-7.
56. Guignard B, Menigaux C, Dupont X, et al. The effect of remifentanil on the bispectral index change and hemodynamic responsed after orotracheal intubation. Anesth Analg,2000,90:161-169.
57. Minto CF, Schnider TW, Egan TD, et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil.Ⅰ .Model development. Anesthesiology, 1997,86:10-23.
58. Minto CF, Schnider TW, Shafer SL. pharmacokinetics and pharmacodynamics of remifentanil.Ⅱ . Model application. Anesthesiology, 1997,86:24-33.
1. Rosow CE. An overview of remifentnil .Anesth Analg ,1999,89(Suppl):S1-3.
2. Minto CF, Schnider TW, Egan TD,et al. Influnence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil: I. Model development. Anesthesiology,1997,86:10-23.
3. Westmoreland CL, Hoke JF, Sebel PS, et al.Pharmacokinetics of remifentanil (GI87084B) and its major metabolite (GI90291) in patients undergoing elective inpatient surgery. Anesthesiology, 1993, 79:893-903.
4. Scott JC, Stanski DR. Decreased fentanyl and alfentanil dose requirements with age. A simultaneous pharmacokinetic and pharmacodynamic evaluation. J Pharmacol Exp Ther ,1987,240:159-166.
5. Lemmens HJ, Bovill JG, Hennis PJ,et al. Age has no effect on the pharmacodynamics of alfentanil. Anesth Analg ,1988,67:956-960.
6. Ausems ME, Hug CC, Stanski DR, et al. Plasma concentrations of alfentanil required to supplement nitrous oxide anesthesia for general surgery. Anesthesiology ,1986, 65:362-373.
7. Glass PSA, Gan TJ, Howell S. A review of the pharmacokinetics and pharmacodynamics of remifentanil. Anesth Analg ,1999,89(Suppl):S7-14.
8. 张卫,李治松,张斯,等. 异丙酚对老年患者瑞芬太尼靶控输注系统效能的影响. 中华麻醉学杂志,2006,26(3):207-210.
9. Merten MJ, Engbers FH, Burm AG, et al. Predictive performance of computer –controlled infusion of remifentanil during propofol/remifentanil anaesthesia. Br J Anaesth, 2003,90:132-141.
10. Hoymork SC, Reder J, Grmsmo B, et al. Bispectral index, predicted and measured drug level of target controlled infusion of remifentanil and propofol during laparoscopic cholecystectomy and emergenced. Acta Anaesth Scand, 2000, 44: 1138-1144.
11. Habib AS, Parker JL, Maguire AM, et al. Effects of remifentanil and alfentanil on thecardiovascular responses to induction of anesthesia and tracheal intubation in the elderly. Br J Anaesth, 2002,88(3):430-433.
12. 张卫,王中玉,庆淑梅,等. 不同速率输注瑞芬太尼对老年患者气管插管反应的影响. 中华麻醉学杂志,2006,26(2):114-117.
13. Maguire AM, Kumar N, Parker JL, et al. Comparison of effects of remifentanil and alfentanil on cardiovascular response to tracheal intubation in hypertensive patients. Br J Anaesth, 2001, 86(1): 90-93.
14. Myre K, Raeder J, Rostrup M, et al. Catecholamine release during laparoscopic fundoplication with high and low doses of remifentanil. Acta Anaesthsiol Scand, 2003,47: 267-273.
15. Jellish WS , Sheikh T , Baker WH , et al . Hemodynamic stability , myocardial ischemia , and perioperative outcome after carotid surgery with remifentanil/ propofol or isoflurane/ fentany1 anesthesia . J Neurosurg Anesthesiol , 2003 , 15 (3) :176 - 184.
16. Bekker A, Berklayd P, Osborn I , et al. The recovery of cognitive function after remifentanil -nitrous oxide anesthesia is faster than after an isoflurane-nitrous oxide-fentanyl combination in elderly patients. Anesth Analg2000; 91:117-122.
17. Kostopanagiotou G, Markantonis SL, Polydorou M,et al. Rocoveruy and cognitive function after fentanyl or remifentanil administration for caroid endarterectomy. J clin Anaesth,2005,17(1): 16-20.
18. 许川雅,吴新民,蒋建渝. 老年患者靶控输注瑞芬太尼和丙泊酚的临床评价.北京大学学报(医学版),2005,37(5):513-515.
19. Gardellin M, Durand M, Maitrasse B, et al. Continuous infusion of remifentanil and target –controlled infusion of propofol for coronary surgery in elderly patients : comparison with continuous infusion of remifentanil and propofol. Annales fran?aise d’ anesthésia et de réanimation, 2004, 23(10): 966-972.
20. Muravchick S. The elderly outpatient : current anesthetic implicatios. Curr Opin Anesthesiol, 2002, 15: 621-625.
21. Moller JT, The ISOPCD investigators. Long-term postoperative cognitive dysfunction in the elderly; ISPOCD1 study. Lancet ,1998, 351: 857-861.
22. Johnson T, Monk T, Rasmussen LS, et al. Postoperative cognitive dysfunction in middle-aged patients. Anesthesiology ,2002, 96: 1351-1357.
23. Guy J , Hindman BJ , Baker KZ , et al . Comparison of remifentanil and fentanyl in patients undergoing craniotomy for supratentorial space-occupying lesion. Anesthesiology, 1997 , 86 : 514-524.
24. Sneyd JR , Whaley A , Dimpel HL , et al . An open , randomized comparison of alfentanil , remifentanil and alfentanil followed by remifentanil in anesthesia for craniotomy. Br J Anaesth 1998; 81:361-364.
25. Larsen B , Seitz A , Larsen R . Recovery of cognitive function after remifentanil- propofol anesthesia: a comparison with desflurane and sevoflurane anesthesia. Anesth Analg,2000,90(1): 168-174.
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