Cheng K I, Chu K S, Fang Y R, Su K C, Lai T W, Chen Y S, Tang C S
Department of Anesthesiology, Kaohsiung Medical University, Taiwan, Republic of China.
Kaohsiung J Med Sci. 1999 Sep;15(9):536-41.
Laparoscopy under total intravenous anesthesia (TIVA) with spontaneous respiration is a commonly encountered procedure in ambulatory gynecologic surgery. The purpose of this study was to evaluate the efficacy of TIVA using propofol and ketamine, compared with endotracheal inhalational general anesthesia (EIGA) for ambulatory gynecologic laparoscopy. Fifty-eight female patients, aged 17-48 years, were randomly allocated into two groups. Group 1 (TIVA) (n = 28) received propofol at the induction of anesthesia followed by propofol infusion for maintenance. Intravenous ketamine 0.5 mg/kg was administered before operation for anesthetic effect. Natural airway and spontaneous breathing were then maintained in patients. Group 2 (n = 30) received EIGA with isoflurane under controlled ventilation. We found that the two groups demonstrated similar trend characters of pH and PaCO2 during operation and in recovery room. The incidence of postoperative vomiting was higher in group 2 than in group 1 (30% vs. 7%; p < 0.05). The incidence of intraoperative arrhythmia was higher in group 2 than in group 1 (40% vs. 3%; p < 0.001). Furthermore, the incidence of sore throat was higher in group 2 than in group 1 (47% vs. 7%; p < 0.001). We conclude that TIVA with spontaneous respiration is suitable for ambulatory gynecologic laparoscopy.
在全凭静脉麻醉（TIVA）下进行的腹腔镜检查并伴有自主呼吸是门诊妇科手术中常见的操作。本研究的目的是评估与气管内吸入全身麻醉（EIGA）相比，使用丙泊酚和氯胺酮的TIVA用于门诊妇科腹腔镜检查的疗效。58名年龄在17 - 48岁的女性患者被随机分为两组。第1组（TIVA）（n = 28）在麻醉诱导时接受丙泊酚，随后输注丙泊酚维持麻醉。术前静脉注射0.5 mg/kg氯胺酮以增强麻醉效果。然后患者保持自然气道和自主呼吸。第2组（n = 30）在控制通气下接受异氟烷的EIGA。我们发现两组在手术期间和恢复室中pH值和动脉血二氧化碳分压（PaCO2）呈现相似的变化趋势。第2组术后呕吐的发生率高于第1组（30%对7%；p < 0.05）。第2组术中心律失常的发生率高于第1组（40%对3%；p < 0.001）。此外，第2组咽痛的发生率高于第1组（47%对7%；p < 0.001）。我们得出结论，伴有自主呼吸的TIVA适用于门诊妇科腹腔镜检查。
