Torri G, Casati A, Albertin A, Comotti L, Bignami E, Scarioni M, Paganelli M
Department of Anesthesiology and Department of General Surgery, Vita-Salute University of Milan, IRCCS H San Raffaele, Via Olgettina, Milan, Italy.
J Clin Anesth. 2001 Dec;13(8):565-70. doi: 10.1016/s0952-8180(01)00330-0.
To compare the efficacy and recovery profile of sevoflurane and isoflurane as the main anesthetics for morbidly obese patients.
Randomized, blinded study.
Inpatients.
30 ASA physical status II and III obese patients [body mass index (BMI) > 35 kg/m(2)] undergoing laparoscopic gastric banding for morbid obesity.
After standard intravenous induction of general anesthesia and tracheal intubation, anesthesia was maintained with either sevoflurane or isoflurane as the main anesthetics. The end-tidal concentrations of the volatile drugs were adjusted to maintain systolic arterial blood pressure within +/-20% from baseline values. When the surgeon started the skin suture, the end-tidal concentration of the inhalational drug was reduced to 0.5 minimum alveolar concentration in both groups. At the last skin suture, the inhalational drug was discontinued and the vaporizator was removed to allow blinded evaluation of the emergence times.
No differences in anesthetic exposure, hemodynamic parameters, incidence of untoward events, or postoperative pain relief were reported between the two groups. Extubation, emergence, and response times were shorter after sevoflurane [6 min (3-15 min), 8 min (5-18 min), and 12 (6-25 min)] than isoflurane [10 min (6-26 min), 14 min (6-21 min), and 21 min (14-41 min)] (p = 0.001, p = 0.03, and p = 0.0005, respectively). The median time for postanesthesia care unit discharge was 15 minutes (25th-75th percentiles: 10-18 min) after sevoflurane and 27 minutes (25th-75th percentiles: 20-30 min) after isoflurane (p = 0.0005).
Sevoflurane provides a safe and effective intraoperative control of cardiovascular homeostasis in morbidly obese patients undergoing laparoscopic gastric banding, with the advantage of a faster recovery and earlier discharge from the postanesthesia care unit than isoflurane.
比较七氟醚和异氟醚作为病态肥胖患者主要麻醉剂的疗效和恢复情况。
随机、双盲研究。
住院患者。
30例美国麻醉医师协会（ASA）身体状况为II级和III级的肥胖患者[体重指数（BMI）> 35 kg/m²]，因病态肥胖接受腹腔镜胃束带手术。
在标准静脉诱导全身麻醉和气管插管后，以七氟醚或异氟醚作为主要麻醉剂维持麻醉。调整挥发性药物的呼气末浓度，使收缩压维持在基线值的±20%以内。当外科医生开始缝合皮肤时，两组吸入药物的呼气末浓度均降至0.5最低肺泡浓度。在最后一针皮肤缝合时，停止吸入药物并移除蒸发器，以便对苏醒时间进行双盲评估。
两组在麻醉暴露、血流动力学参数、不良事件发生率或术后疼痛缓解方面均无差异。七氟醚组拔管、苏醒和反应时间[分别为6分钟（3 - 15分钟）、8分钟（5 - 18分钟）和12分钟（6 - 25分钟）]比异氟醚组[分别为10分钟（6 - 26分钟）、14分钟（6 - 21分钟）和21分钟（14 - 41分钟）]短（p分别为0.001、0.03和0.0005）。七氟醚麻醉后麻醉后监护病房出院的中位时间为15分钟（第25 - 75百分位数：10 - 18分钟），异氟醚麻醉后为27分钟（第25 - 75百分位数：20 - 30分钟）（p = 0.0005）。
对于接受腹腔镜胃束带手术的病态肥胖患者，七氟醚能在术中安全有效地控制心血管稳态，与异氟醚相比，具有恢复更快、从麻醉后监护病房更早出院的优势。
