Grundmann U, Silomon M, Bach F, Becker S, Bauer M, Larsen B, Kleinschmidt S
Department of Anaesthesiology and Critical Care Medicine, University of Saarland, Homburg/Saar, Germany.
Acta Anaesthesiol Scand. 2001 Mar;45(3):320-6. doi: 10.1034/j.1399-6576.2001.045003320.x.
Nitrous oxide (N2O) has been suggested to contribute to bowel distension, resulting in worsened operating conditions for laparoscopic surgery, and to increase incidence of postoperative nausea and vomiting. Therefore, our objective was to assess the feasibility of two remifentanil-based anaesthetic regimens free from N2O with special regard to recovery profile, postoperative analgesic demand and side effects in patients undergoing laparoscopic cholecystectomy.
Fifty patients (ASA I-II, 23-65 yr) were randomly assigned to receive remifentanil-based anaesthesia in conjunction with propofol (group R/P) or desflurane (group R/D). After standardised induction of anaesthesia, analgesia was continued with remifentanil in all patients. For maintenance of hypnosis, propofol or desflurane were used in concentrations to ensure loss of consciousness, lack of awareness, and maintenance of heart rate and blood pressure within +/- 25% of initial values. At the end of surgery all anaesthetics were discontinued without tapering and early emergence and recovery were recorded. Pain scores were assessed by using a visual analogue scale. Patient-controlled analgesia with i.v. piritramide was used for treatment of postoperative pain and recorded for 90 min in the postanaesthesia care unit (PACU). In addition, side effects were noted.
Early emergence from anaesthesia did not differ between the groups. In group R/P, time to eye opening, spontaneous respiration and extubation was 4.4 +/- 2.9 min, 5.2 +/- 3.4 min and 5.5 +/- 3.3 min respectively, compared with 4.7 +/- 2.7 min, 5.3 +/- 2.4 min and 5.7 +/- 2.5 min in group R/D. While pain scores did not differ between both groups on admission to the PACU, patients receiving desflurane required more i.v. piritramide as compared to those receiving propofol, 22.0 +/- 6.5 mg and 17.9 +/- 7.0 mg, respectively (P<0.05). Nausea was less frequent after propofol (16% vs. 48%, P<0.05).
In patients undergoing laparoscopic cholecystectomy, remifentanil-based anaesthetic regimens in conjunction with propofol or desflurane are suitable and allow for rapid recovery from anaesthesia. However, the use of propofol results in less postoperative analgesic consumption and nausea as compared to desflurane.
有人认为氧化亚氮（N₂O）会导致肠扩张，从而使腹腔镜手术的操作条件恶化，并增加术后恶心和呕吐的发生率。因此，我们的目的是评估两种不含N₂O的瑞芬太尼麻醉方案在腹腔镜胆囊切除术患者中的可行性，特别关注恢复情况、术后镇痛需求和副作用。
50例患者（ASA I-II级，23 - 65岁）被随机分配接受瑞芬太尼联合丙泊酚的麻醉（R/P组）或地氟醚的麻醉（R/D组）。在标准化麻醉诱导后，所有患者均继续使用瑞芬太尼镇痛。为维持催眠状态，丙泊酚或地氟醚以确保意识丧失、无知晓以及心率和血压维持在初始值±25%范围内的浓度使用。手术结束时，所有麻醉药均不减量停药，并记录早期苏醒和恢复情况。使用视觉模拟量表评估疼痛评分。术后疼痛治疗采用静脉注射匹米诺定的患者自控镇痛，并在麻醉后恢复室（PACU）记录90分钟。此外，记录副作用。
两组患者的麻醉早期苏醒情况无差异。在R/P组，睁眼、自主呼吸和拔管时间分别为4.4±2.9分钟、5.2±3.4分钟和5.5±3.3分钟，而R/D组分别为4.7±2.7分钟、5.3±2.4分钟和5.7±2.5分钟。虽然两组患者进入PACU时疼痛评分无差异，但与接受丙泊酚的患者相比，接受地氟醚的患者需要更多的静脉注射匹米诺定，分别为22.0±6.5毫克和17.9±7.0毫克（P<0.05）。丙泊酚组恶心发生率较低（16%对48%，P<0.05）。
在接受腹腔镜胆囊切除术的患者中，瑞芬太尼联合丙泊酚或地氟醚的麻醉方案是合适的，且能使患者快速从麻醉中恢复。然而，与地氟醚相比，丙泊酚的使用导致术后镇痛药物消耗更少且恶心发生率更低。
