七氟烷用于ICU患者术后镇静？​

重症监护室内患者使用镇静剂的比例很高，常用的镇静剂包括异丙酚、咪达唑仑和右美托咪定等。但这些都是静脉药物，你尝试过将吸入麻醉药用于术后镇静吗？这篇文章探讨了七氟烷用于术后镇静的初始剂量，及其与异丙酚镇静相比阿片类药物使用量的差异！

重症监护病房术后病人吸入镇静：七氟烷初始浓度及与异丙酚镇静时阿片类药物剂量比较

背景：虽然在欧洲重症监护病房（ICU）使用挥发性镇静剂的人数在增加，但在亚洲仍然很少。因此，没有可用的临床指南。本研究探讨了头颈部气管切开术患者七氟烷镇静的适当初始浓度，七氟烷是一种易挥发性镇静剂，可使躁动镇静评分（RASS）评分为-2到-3。我们还比较了术后吸入镇静和静脉注射镇静的阿片类药物消耗量。

方法：我们计划进行一项前瞻性研究，以确定七氟烷吸入镇静的初始浓度，并回顾性分析比较术后七氟烷吸入镇静和异丙酚静脉注射镇静下阿片类药物的消耗情况。计划在ICU进行头颈部手术并随后在ICU进行镇静的患者被纳入本研究。

结果：在这项前瞻性研究中，保序回归分析结果显示七氟烷的ED50为0.36%（95%可信区间[CI]为0.20-0.60%），ED95为0.69%（95%CI：0.60-0.75%）。

在这项回顾性研究中，七氟烷组术后镇静期间的瑞芬太尼消耗量（2.52±1.00µg/kg/hr，P=0.001）显著低于静脉注射异丙酚组（3.66±1.30µg/kg/hr）。

结论：确定了头颈外科气切患者术后七氟烷镇静的初始浓度。术后七氟烷镇静是异丙酚静脉镇静的一种安全有效的替代方法。

Inhalation sedation for postoperativepatients in the intensive care unit: initial sevoflurane concentration andcomparison of opioid use with propofol sedation

Background: Although the use of volatilesedatives in the intensive care unit (ICU) is increasing in Europe, it remainsinfrequent in Asia. Therefore, there are no clinical guidelines available. Thisstudy investigates the proper initial concentration of sevoflurane, a volatilesedative that induces a Richmond agitation-sedation scale (RASS) score of -2 to-3, in patients who underwent head and neck surgery with tracheostomy. We alsocompared the amount of postoperative opioid consumption between volatile andintravenous (IV) sedation.

Methods: We planned a prospective study todetermine the proper initial sevoflurane concentration and a retrospectiveanalysis to compare postoperative opioid consumption between volatile sedationand propofol sedation. Patients scheduled for head and neck surgery withtracheostomy and subsequent postoperative sedation in the ICU were enrolled.

Results: In this prospective study, theeffective dose 50 (ED50) of sevoflurane concentration was 0.36 % (95%confidence interval [CI], 0.20 to 0.60%), while the ED 95 was 0.69% (95% CI,0.60 to 0.75%) based on isotonic regression methods. In this retrospectivestudy, remifentanil consumption during postoperative sedation was significantlylower in the sevoflurane group (2.52±1.00 µg/kg/hr, P=0.001) than it was in theIV propofol group (3.66±1.30 µg/kg/hr).

Conclusion: We determined the properinitial end-tidal concentration setting of sevoflurane for patients withtracheostomy who underwent head and neck surgery. Postoperative sedation withsevoflurane appears to be a valid and safe alternative to IV sedation withpropofol.

Keywords: AnaConDa; analgesics; anesthesia;postoperative period; sevoflurane.