McFarlane M E
Department of Surgery, Radiology, Anaesthesia and Intensive Care, Faculty of Medical Sciences, University of the West Indies, Kingston, Jamaica.
West Indian Med J. 2000 Jun;49(2):158-60.
The objective of this study was to determine whether analgesia-sedation improved patient acceptance of day-case herniorrhaphy and to evaluate the extent of patient morbidity. A total of 98 patients (mean age 34 years, range 17-75 years) were studied before and after herniorrhaphy to determine their response to the procedure. All patients were unpremedicated and underwent herniorrhaphy using a Bassini repair technique with a standard local anaesthetic block. Sedation was obtained with titrated intravenous midazolam(Hypnovel, Roche Products Ltd.) without narcotic analgesia. Patients were evaluated with a simple questionnaire after surgery. The maximum dose of midazolam used was 5 mg (median dose 3.5 mg). Monitoring of vital signs with pulse oximetry during the operative period was routine though oxygen therapy was not required. All patients were able to walk without assistance and were discharged under responsible supervision. Operative morbidity was low (5%). Adverse reactions to the procedure such as nausea, vomiting and headache were not seen. In conclusion, conscious sedation allows amnesia to be achieved with low morbidity in the majority of patients undergoing local anaesthetic procedures. This should result in increased patient acceptance.
本研究的目的是确定镇痛镇静是否能提高日间疝修补术患者的接受度，并评估患者的发病程度。共有98例患者（平均年龄34岁，范围17 - 75岁）在疝修补术前和术后接受研究，以确定他们对该手术的反应。所有患者均未进行术前用药，采用标准局部麻醉阻滞的巴西尼修补技术进行疝修补术。通过静脉滴定咪达唑仑（力月西，罗氏产品有限公司）实现镇静，未使用麻醉性镇痛药。术后通过简单问卷对患者进行评估。咪达唑仑的最大用量为5 mg（中位剂量3.5 mg）。手术期间常规使用脉搏血氧饱和度仪监测生命体征，不过无需吸氧治疗。所有患者均可独立行走，并在专人负责监督下出院。手术发病率较低（5%）。未观察到手术相关的不良反应，如恶心、呕吐和头痛。总之，清醒镇静可使大多数接受局部麻醉手术的患者实现遗忘，且发病率较低。这应会提高患者的接受度。
