Scholarlink

<p>Skull pin fixation during neurosurgery induces intense nociceptive and hemodynamic responses. Dexmedetomidine is commonly used in anesthesia to enhance perioperative stability; however, its optimal plasma concentration (Cp) when combined with remifentanil at a fixed effect-site concentration (Ce) remains undefined. This prospective study enrolled 24 patients undergoing intracranial surgery to determine the 95% effective concentration (EC<sub>95</sub>) of dexmedetomidine for skull pin fixation using the analgesia nociception index (ANI) and hemodynamic parameters. Anesthesia was maintained with propofol and remifentanil (Ce: 2.0 ng/mL), with dexmedetomidine administered via target-controlled infusion (TCI). The initial Cp of dexmedetomidine was set at 0.4 ng/mL and adjusted in 0.05 ng/mL increments using a modified up-and-down method. Analgesia was deemed successful if ANI ≥ 30 with mean arterial pressure (MAP) and heart rate (HR) within ± 20% of baseline values. Probit regression analysis revealed EC<sub>50</sub> and EC<sub>95</sub> of dexmedetomidine at 0.325 ng/mL and 0.395 ng/mL, respectively, for maintaining nociceptive and hemodynamic stability. Dexmedetomidine Cp below 0.3 ng/mL were associated with greater fluctuations in ANI, MAP, and HR. ANI &lt; 30 demonstrated a sensitivity of 81.8% and a specificity of 100% for detecting analgesic failure. These findings suggest that when remifentanil is maintained at a Ce of 2.0 ng/mL, a dexmedetomidine Cp of 0.395 ng/mL provides optimal nociceptive and hemodynamic control during skull pin fixation, supporting the use of individualized dexmedetomidine titration and ANI-guided multimodal monitoring in neurosurgical anesthesia.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Plasma concentration of dexmedetomidine combined with fixed remifentanil for nociceptive and hemodynamic control during skull pin fixation

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年4月27日

查看全文
  • Wei-Cheng Tseng,
  • Ann‑Shung Lieu,
  • Yu-Chi Tu,
  • Yu-Feng Su,
  • Tsai-Shan Wu,
  • Yi-Wei Kuo,
  • Zhi-Fu Wu

摘要

Skull pin fixation during neurosurgery induces intense nociceptive and hemodynamic responses. Dexmedetomidine is commonly used in anesthesia to enhance perioperative stability; however, its optimal plasma concentration (Cp) when combined with remifentanil at a fixed effect-site concentration (Ce) remains undefined. This prospective study enrolled 24 patients undergoing intracranial surgery to determine the 95% effective concentration (EC95) of dexmedetomidine for skull pin fixation using the analgesia nociception index (ANI) and hemodynamic parameters. Anesthesia was maintained with propofol and remifentanil (Ce: 2.0 ng/mL), with dexmedetomidine administered via target-controlled infusion (TCI). The initial Cp of dexmedetomidine was set at 0.4 ng/mL and adjusted in 0.05 ng/mL increments using a modified up-and-down method. Analgesia was deemed successful if ANI ≥ 30 with mean arterial pressure (MAP) and heart rate (HR) within ± 20% of baseline values. Probit regression analysis revealed EC50 and EC95 of dexmedetomidine at 0.325 ng/mL and 0.395 ng/mL, respectively, for maintaining nociceptive and hemodynamic stability. Dexmedetomidine Cp below 0.3 ng/mL were associated with greater fluctuations in ANI, MAP, and HR. ANI < 30 demonstrated a sensitivity of 81.8% and a specificity of 100% for detecting analgesic failure. These findings suggest that when remifentanil is maintained at a Ce of 2.0 ng/mL, a dexmedetomidine Cp of 0.395 ng/mL provides optimal nociceptive and hemodynamic control during skull pin fixation, supporting the use of individualized dexmedetomidine titration and ANI-guided multimodal monitoring in neurosurgical anesthesia.