Gupta A, Larsen L E, Sjöberg F, Lindh M L, Lennmarken C
Department of Anaesthesia and Intensive Care, University Hospital, Linköping, Sweden.
Acta Anaesthesiol Scand. 1992 Oct;36(7):670-4. doi: 10.1111/j.1399-6576.1992.tb03541.x.
This study compares psychomotor recovery following induction of anaesthesia with either thiopentone or propofol in 30 healthy, unpremedicated patients undergoing outpatient arthroscopic procedures of the knee. A battery of tests including simple reaction time (SRT), choice reaction time (CRT), perceptive accuracy test (PAT) and digit symbol substitution test (DSST) were done before anaesthesia. The patients were randomly divided into two groups: Group 1 was induced with thiopentone 5-6 mg/kg while Group 2 was induced with propofol 2-3 mg/kg. Anaesthesia was then maintained with isoflurane (0.5-2%) in oxygen and air, and supplements of alfentanil were given for analgesia during spontaneous respiration with a face mask. Psychomotor recovery assessed every 30 min postoperatively for 120 min showed that patients in Group 1 had not returned to baseline values until 120 min after the operation on the PAT, while those in Group 2 had returned to baseline values at 60 min. No patient had any significant side effects. The SRT, CRT and DSST proved to be relatively insensitive in the detection of residual effects of anaesthesia and had a significant learning effect. This study suggests that induction of anaesthesia with propofol followed by maintenance with isoflurane in oxygen and air during spontaneous ventilation is associated with rapid psychomotor recovery and is a suitable method for ambulatory surgery. The PAT is sensitive and not associated with some of the problems found with other commonly used tests.
本研究比较了30例接受门诊膝关节关节镜手术的健康、未使用术前药的患者，分别使用硫喷妥钠或丙泊酚诱导麻醉后的精神运动恢复情况。在麻醉前进行了一系列测试，包括简单反应时间（SRT）、选择反应时间（CRT）、感知准确性测试（PAT）和数字符号替代测试（DSST）。患者被随机分为两组：第1组用5 - 6mg/kg硫喷妥钠诱导，第2组用2 - 3mg/kg丙泊酚诱导。然后用异氟醚（0.5 - 2%）在氧气和空气中维持麻醉，在面罩自主呼吸期间给予阿芬太尼补充镇痛。术后每隔30分钟评估120分钟的精神运动恢复情况，结果显示，第1组患者在PAT测试中直到术后120分钟才恢复到基线值，而第2组患者在60分钟时就恢复到了基线值。没有患者出现任何明显的副作用。SRT、CRT和DSST在检测麻醉残留效应方面相对不敏感，且有显著的学习效应。本研究表明，丙泊酚诱导麻醉，随后在自主通气期间用异氟醚在氧气和空气中维持麻醉，与快速的精神运动恢复相关，是门诊手术的合适方法。PAT敏感，且不存在其他常用测试中发现的一些问题。
