リミフェンタニルと神経筋肉阻害剤の効果 急速配列インチューブによるインチューブ成功 合併症のない患者における吸血のリスク: ランダム化臨床試験
Nicolas Grillot1, Gilles Lebuffe2, Olivier Huet3
1Nantes Université, CHU Nantes, Service d'Anesthésie Réanimation Chirurgicale, INSERM CIC 0004 Immunologie et Infectiologie, Nantes, France.
JAMA
|January 3, 2023
まとめ
レミフェンタニルは神経筋阻害薬より劣らぬ効果を示さなかった. この急速発症するオピオイドは 統計的に劣った結果を示し 最初の試行錯誤で大きな合併症は発生しなかった.
科学分野:
- 麻酔科
- クリティカル ケア 医療
- 薬理学について
背景:
- ラピッドシーケンスの挿管 (RSI) は,呼吸道管理の重要な手順です.
- オピオイドや神経筋阻害剤を含む補助剤の選択は,RSIの成功と安全性に影響します.
- RSI時の神経筋阻害薬と比較して,急速発症オピオイドの非劣等性については不確実性があります.
研究 の 目的:
- リミフェンタニルが,RSI時の成功性のある気管管挿管に対して,早発症神経筋阻害剤に劣らないかどうかを判断する.
- RSIにおける各剤に関連した主要な合併症の発生率を比較する.
主な方法:
- 1150人のアスピレーションリスクのある成人を対象とした多センター,ランダム化,オープンな非劣等性試験です.
- 患者は,催眠薬投与後,神経筋肉阻害剤 (スッキニルコリンまたはロキュロニウム) またはレミフェンタニルを投与された.
- 主なアウトカムは,重大な合併症のない呼吸道管内置の初試行であり,7. 0%の非劣等差が事前に指定された.
主要な成果:
- ランダム化された集団では,レミフェンタニル群の66. 1%,神経筋阻害薬群の71. 6%で,重大な合併症のない成功した挿管が発生した (調整された差異: - 6. 1%,95%CI, - 11. 6%から - 0. 5%).
- この研究では,レミフェンタニルの統計的劣等性 (非劣等性についてはP=.37) が示された.
- ヘモダイナミック不安定性の有害事象は,神経筋阻害薬群 (0. 5%) と比較してレミフェンタニル群 (3. 3%) でより頻繁であった.
結論:
- レミフェンタニルは,神経筋阻害剤と比較して,RSIの非劣等性基準を満たさなかった.
- 統計的に劣っているが,レミフェンタニルの広い信頼区間は,神経筋肉阻害剤と比較して臨床的関連性がさらなる調査を必要としていることを示唆している.
- 研究結果は,神経筋阻害薬が,アスピレーションのリスクのある患者におけるRSIの好ましい選択であることを示唆しています.
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