Zestos Maria M, Bhattacharya Debashish, Rajan Sankar, Kemper Sharon, Haupert Michael
Department of Anesthesia, Children's Hospital of Michigan, 3901 Beaubien, Detroit, MI 48201, USA
Laryngoscope. 2004 Feb;114(2):212-5. doi: 10.1097/00005537-200402000-00007.
This study compared the anesthetic gas exposure and operating conditions during insufflation anesthesia with halothane-alone versus halothane-propofol in children undergoing direct laryngobronchoscopy.
Forty-six children were enrolled in this randomized prospective study, with institutional review board approval and informed consent.
All children were anesthetized by halothane mask induction and anesthesia was maintained using spontaneous ventilation with insufflation. No muscle relaxants or opioids were used. In the halothane group, halothane was titrated as needed. In the propofol group, halothane was decreased to 1% inspired concentration and the propofol was titrated as needed to maintain spontaneous ventilation and a still patient. Trace anesthetic gases, hemodynamic stability, and operating conditions were measured.
The groups were similar in age, weight, and bronchoscopy time. There was significantly less gas exposure in the propofol group (25 +/- 33 parts per million) versus the halothane group (66 +/- 97 ppm; P <.02). There was a trend toward earlier emergence in the halothane group (33 +/- 13 minutes) versus the propofol group (41 +/- 17 minutes). Postoperative stridor was common, occurring in 30% of children.
Insufflation anesthesia with spontaneous respiration provides excellent surgical conditions for laryngobronchoscopy. The addition of propofol resulted in fewer airway complications (P =.047). Although the addition of propofol significantly decreased anesthetic gas exposure in the operating room, both techniques resulted in operating room pollution that exceeded the maximum levels of 2 ppm per hour recommended by the US National Institute for Occupational Safety and Health (NIOSH).
本研究比较了在接受直接喉镜支气管镜检查的儿童中，单纯使用氟烷与氟烷 - 丙泊酚进行吹入麻醉时的麻醉气体暴露情况和手术条件。
46名儿童参与了这项随机前瞻性研究，获得了机构审查委员会的批准并取得了知情同意。
所有儿童均通过氟烷面罩诱导麻醉，并采用吹入法自主通气维持麻醉。未使用肌肉松弛剂或阿片类药物。在氟烷组中，根据需要滴定氟烷。在丙泊酚组中，将氟烷吸入浓度降至1%，并根据需要滴定丙泊酚以维持自主通气和患儿安静。测量微量麻醉气体、血流动力学稳定性和手术条件。
两组在年龄、体重和支气管镜检查时间方面相似。丙泊酚组的气体暴露量（25±33百万分率）显著低于氟烷组（66±97 ppm；P<.02）。氟烷组（33±13分钟）的苏醒时间有早于丙泊酚组（41±17分钟）的趋势。术后喘鸣很常见，30%的儿童出现。
自主呼吸吹入麻醉为喉镜支气管镜检查提供了良好的手术条件。添加丙泊酚可减少气道并发症（P = 0.047）。虽然添加丙泊酚显著降低了手术室中的麻醉气体暴露，但两种技术都导致手术室污染超过了美国国家职业安全与健康研究所（NIOSH）推荐的每小时2 ppm的最高水平。
