Watson K R, Shah M V
Department of Anaesthetics, General Infirmary at Leeds, UK.
Br J Anaesth. 2000 Oct;85(4):541-6. doi: 10.1093/bja/85.4.541.
The introduction of total intravenous anaesthesia (TIVA) and the use of volatile induction/maintenance anaesthesia (VIMA) has led to the rediscovery of 'single agent' anaesthesia, eliminating the transition phase from induction to maintenance. We compared quality, patient acceptability and cost of TIVA using target control infusion (TCI) with propofol and VIMA with sevoflurane. Forty patients undergoing spinal surgery of 1-3 h were assigned to one of two groups. Group I received propofol-air-oxygen for induction followed by propofol-air-oxygen for maintenance. Group II received 8% sevoflurane-oxygen for induction and sevoflurane-oxygen-nitrous oxide for maintenance. Propofol had a significantly faster mean (SD) induction time (67 (20) s) than sevoflurane (97 (38) s) but was associated with double the incidence of involuntary movements. Although not significant, twice the number of interventions by the anaesthetist were required to maintain an adequate level of anaesthesia in the sevoflurane group. Emergence times, characteristics, postoperative nausea, vomiting and pain were unaffected by the anaesthetic technique. However, a more predictable emergence time was found following sevoflurane. Cardiovascular stability was good and comparable in both groups. The majority of patients found either technique acceptable and would choose the same anaesthetic again. Induction and maintenance was substantially cheaper with sevoflurane (28.06 Pounds) compared with propofol (41.43 Pounds).
全静脉麻醉（TIVA）的引入以及挥发性诱导/维持麻醉（VIMA）的使用，使得“单一药物”麻醉得以重新被发现，消除了从诱导到维持的过渡阶段。我们比较了使用丙泊酚靶控输注（TCI）的TIVA与使用七氟醚的VIMA在质量、患者可接受性和成本方面的差异。40例接受1 - 3小时脊柱手术的患者被分为两组。第一组诱导时使用丙泊酚 - 空气 - 氧气，维持时使用丙泊酚 - 空气 - 氧气。第二组诱导时使用8%七氟醚 - 氧气，维持时使用七氟醚 - 氧气 - 氧化亚氮。丙泊酚的平均（标准差）诱导时间（67（20）秒）明显快于七氟醚（97（38）秒），但不自主运动的发生率是七氟醚的两倍。虽然差异不显著，但七氟醚组需要麻醉医生进行干预的次数是丙泊酚组的两倍才能维持足够的麻醉深度。苏醒时间、特征、术后恶心、呕吐和疼痛不受麻醉技术的影响。然而，七氟醚麻醉后的苏醒时间更可预测。两组的心血管稳定性良好且相当。大多数患者认为两种技术都可以接受，并且愿意再次选择相同的麻醉方式。与丙泊酚（41.43英镑）相比，七氟醚的诱导和维持成本显著更低（28.06英镑）。
