Fredman Brian, Sheffer Offer, Zohar Edna, Paruta Irena, Richter Santiago, Jedeikin Robert, White Paul F
Departments of Anesthesiology and Intensive Care and Urology, Meir Hospital, Kfar Saba, Israel.
Anesth Analg. 2002 Mar;94(3):560-4; table of contents. doi: 10.1097/00000539-200203000-00015.
Our primary objective was to assess the feasibility of geriatric patients (>65 yr) bypassing the postanesthesia care unit (PACU) after ambulatory surgery. A secondary objective was to compare recovery profiles when using three different maintenance anesthetics. Ninety ASA physical status I--III consenting outpatients (>65 yr) undergoing short urologic procedures were randomly assigned to one of three anesthetic treatment groups. After a standardized induction with fentanyl and propofol, anesthesia was maintained with propofol (75-150 microg center dot kg(-1) center dot min(-1) IV), isoflurane (0.7%-1.2% end tidal), or desflurane (3%-6% end tidal), in combination with nitrous oxide 70% in oxygen. In all three groups, the primary anesthetic was titrated to maintain an electroencephalographic-bispectral index value of 60-65. Recovery times, postanesthesia recovery scores, and therapeutic interventions in the PACU were recorded. Although emergence times were similar in the three groups, the time to achieve a fast-track discharge score of 14 was significantly shorter in patients receiving desflurane compared with propofol and isoflurane (22 +/- 23 vs 33 +/- 25 and 44 +/- 36 min, respectively). On arrival in the PACU, a significantly larger percentage of patients receiving desflurane were judged to be fast-track eligible compared with those receiving either isoflurane and propofol (73% vs 43% and 44%, respectively). The number of therapeutic interventions in the PACU was also significantly larger in the Isoflurane group when compared with the Propofol and Desflurane groups (21 vs 11 and 7, respectively). In conclusion, use of desflurane for maintenance of anesthesia should facilitate PACU bypass ("fast-tracking") of geriatric patients undergoing short urologic procedures.
Geriatric outpatients undergoing brief urologic procedures more rapidly achieve fast-tracking discharge criteria after desflurane (versus isoflurane and propofol) anesthesia. Use of isoflurane was also associated with an increased need for nursing interventions in the early recovery period compared with desflurane and propofol.
我们的主要目标是评估老年患者（>65岁）在门诊手术后绕过麻醉后监护病房（PACU）的可行性。次要目标是比较使用三种不同维持麻醉剂时的恢复情况。九十例年龄>65岁、美国麻醉医师协会（ASA）身体状况分级为I-III级且同意参与研究的门诊患者，接受短小泌尿外科手术，被随机分配至三个麻醉治疗组之一。在使用芬太尼和丙泊酚进行标准化诱导后，分别用丙泊酚（静脉输注，75 - 150μg·kg⁻¹·min⁻¹）、异氟烷（呼气末浓度0.7% - 1.2%）或地氟烷（呼气末浓度3% - 6%）维持麻醉，并联合70%氧化亚氮和氧气。在所有三组中，主要麻醉剂均进行滴定以维持脑电双频指数值在60 - 65。记录恢复时间、麻醉后恢复评分以及在PACU中的治疗干预情况。虽然三组的苏醒时间相似，但与接受丙泊酚和异氟烷的患者相比，接受地氟烷的患者达到快速出院评分14分的时间显著更短（分别为22±23分钟、33±25分钟和44±36分钟）。与接受异氟烷和丙泊酚的患者相比，到达PACU时，接受地氟烷的患者中被判定符合快速出院条件的比例显著更高（分别为73%、43%和44%）。与丙泊酚组和地氟烷组相比，异氟烷组在PACU中的治疗干预次数也显著更多（分别为21次、11次和7次）。总之，对于接受短小泌尿外科手术的老年患者，使用地氟烷维持麻醉应有助于绕过PACU（“快速通道”）。
与异氟烷和丙泊酚相比，接受短小泌尿外科手术的老年门诊患者在使用地氟烷麻醉后能更快达到快速出院标准。与地氟烷和丙泊酚相比，使用异氟烷在早期恢复阶段对护理干预的需求也增加。
