Tang J, Chen L, White P F, Watcha M F, Wender R H, Naruse R, Kariger R, Sloninsky A
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 75235-9068, USA.
Anesthesiology. 1999 Jul;91(1):253-61. doi: 10.1097/00000542-199907000-00034.
Office-based surgery is becoming increasingly popular because of its cost-saving potential Both propofol and sevoflurane are commonly used in the ambulatory setting because of their favorable recovery profiles. This clinical investigation was designed to compare the clinical effects, recovery characteristics, and cost-effectiveness of propofol and sevoflurane when used alone or in combination for office-based anesthesia.
One hundred four outpatients undergoing superficial surgical procedures at an office-based surgical center were randomly assigned to one of three general anesthetic groups. In groups I and II, propofol 2 mg/kg was administered for induction followed by propofol 75-150 microg x kg(-1) x min(-1) (group I) or sevoflurane 1-2% (group II) with N2O 67% in oxygen for maintenance of anesthesia In group m, anesthesia was induced and maintained with sevoflurane in combination with N2O 67% in oxygen. Local anesthetics were injected at the incision site before skin incision and during the surgical procedure. The recovery profiles, costs of drugs, and resources used, as well as patient satisfaction, were compared among the three treatment groups.
Although early recovery variables (e.g., eye opening, response to commands, and sitting up) were similar in all three groups, the times to standing up and to be "home ready" were significantly prolonged when sevoflurane-N2O was used for both induction and maintenance of anesthesia. The time to tolerating fluids, recovery room stay, and discharge times were significantly decreased when propofol was used for both induction and maintenance of anesthesia. Similarly, the incidence of postoperative nausea and vomiting and the need for rescue antiemetics were also significantly reduced after propofol anesthesia. Finally, the total costs and patient satisfaction were more favorable when propofol was used for induction and maintenance of office-based anesthesia
Compared with sevoflurane-N2O, use of propofol-N2O for office-based anesthesia was associated with an improved recovery profile, greater patient satisfaction, and lower costs. There were significantly more patients who were dissatisfied with the sevoflurane anesthetic technique.
由于具有节省成本的潜力，门诊手术越来越受欢迎。丙泊酚和七氟醚因其良好的恢复特征，常用于门诊手术。本临床研究旨在比较丙泊酚和七氟醚单独使用或联合用于门诊麻醉时的临床效果、恢复特征及成本效益。
104例在门诊手术中心接受浅表外科手术的门诊患者被随机分配至三个全身麻醉组之一。在I组和II组中，诱导时给予丙泊酚2mg/kg，随后I组给予丙泊酚75 - 150μg·kg⁻¹·min⁻¹，II组给予七氟醚1% - 2%并联合67%氧化亚氮用于维持麻醉。在III组中，麻醉诱导和维持均使用七氟醚联合67%氧化亚氮。在皮肤切开前及手术过程中在切口部位注射局部麻醉药。比较三个治疗组的恢复情况、药物成本、资源使用情况以及患者满意度。
虽然所有三组的早期恢复指标（如睁眼、对指令的反应和坐起）相似，但当七氟醚 - 氧化亚氮用于麻醉诱导和维持时，站立时间和“准备回家”时间显著延长。当丙泊酚用于麻醉诱导和维持时，耐受液体时间、恢复室停留时间和出院时间显著缩短。同样，丙泊酚麻醉后术后恶心呕吐的发生率及使用抢救性止吐药的需求也显著降低。最后，当丙泊酚用于门诊麻醉的诱导和维持时，总成本和患者满意度更佳。
与七氟醚 - 氧化亚氮相比，丙泊酚 - 氧化亚氮用于门诊麻醉可改善恢复情况，提高患者满意度并降低成本。对七氟醚麻醉技术不满意的患者明显更多。
