レミフェンタニル含有全身麻酔における血漿グリシン濃度変化:前向き観察パイロットスタディ
Takao Kato1, Kikumi Matsuoka2, Asako Nagane3
1Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN.
Cureus
|December 15, 2025
まとめ
グリシン含有レミフェンタニル麻酔では、ほとんどの患者で血漿グリシンレベルが上昇しなかった。これにより、術後悪寒およびオピオイド誘発性痛覚過敏におけるN-メチル-D-アスパラギン酸受容体の関与の評価が制限される。
科学分野:
- 麻酔科学および薬理学
- 神経科学
- 疼痛管理
背景:
- レミフェンタニル麻酔は、術後悪寒(PAS)およびオピオイド誘発性痛覚過敏(OIH)と関連している。
- PASおよびOIHはともにN-メチル-D-アスパラギン酸(NMDA)受容体シグナル伝達が関与する可能性があり、グリシンは共同作動薬として作用する。
- 市販のレミフェンタニルにはグリシンが含まれており、周術期のグリシンレベルの変化を調査するきっかけとなった。
主な方法:
- 待機的膵十二指腸切除術を受けた成人患者10例を対象とした前向き観察研究。
- デズフルラン、プロポフォール、およびレミフェンタニル(グリシン含有)を用いた平衡麻酔。
- 6つの時点での血漿グリシン測定。術後悪寒、疼痛、せん妄を探索的に評価した。
結論:
- グリシン含有レミフェンタニル麻酔では、臓器機能が保たれたほとんどの患者で血漿グリシンが上昇しなかった。
- この所見は、この文脈におけるPASおよびOIHのNMDA受容体媒介メカニズムの評価を制限する。
- さらなる研究では、高濃度レミフェンタニルまたは併用グリシン製剤を検討すべきである。
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