Gupta Anil, Stierer Tracey, Zuckerman Rhonda, Sakima Neal, Parker Stephen D, Fleisher Lee A
Department of Anesthesiology and Critical Care, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Anesth Analg. 2004 Mar;98(3):632-41, table of contents. doi: 10.1213/01.ane.0000103187.70627.57.
In this systematic review we focused on postoperative recovery and complications using four different anesthetic techniques. The database MEDLINE was searched via PubMed (1966 to June 2002) using the search words "anesthesia" and with ambulatory surgical procedures limited to randomized controlled trials in adults (>19 yr), in the English language, and in humans. A second search strategy was used combining two of the words "propofol," "isoflurane," "sevoflurane," or "desflurane". Screening and data extraction produced 58 articles that were included in the final meta-analysis. No differences were found between propofol and isoflurane in early recovery. However, early recovery was faster with desflurane compared with propofol and isoflurane and with sevoflurane compared with isoflurane. A minor difference was found in home readiness between sevoflurane and isoflurane (5 min) but not among the other anesthetics. Nausea, vomiting, headache, and postdischarge nausea and vomiting incidence were in favor of propofol compared with isoflurane (P < 0.05). A larger number of patients in the inhaled anesthesia groups required antiemetics compared with the propofol group. We conclude that the differences in early recovery times among the different anesthetics were small and in favor of the inhaled anesthetics. The incidence of side effects, specifically postoperative nausea and vomiting, was less frequent with propofol.
A systematic analysis of the literature comparing postoperative recovery after propofol, isoflurane, desflurane, and sevoflurane-based anesthesia in adults demonstrated that early recovery was faster in the desflurane and sevoflurane groups. The incidence of nausea and vomiting were less frequent with propofol.
在本系统评价中，我们聚焦于使用四种不同麻醉技术后的术后恢复及并发症情况。通过PubMed检索MEDLINE数据库（1966年至2002年6月），检索词为“麻醉”，并将门诊手术程序限定为针对成年人（>19岁）的随机对照试验，语言为英语且研究对象为人类。采用了第二种检索策略，将“丙泊酚”“异氟烷”“七氟烷”或“地氟烷”中的两个词进行组合。筛选和数据提取后得到58篇文章，纳入最终的荟萃分析。在早期恢复方面，丙泊酚和异氟烷之间未发现差异。然而，与丙泊酚和异氟烷相比，地氟烷组的早期恢复更快，与异氟烷相比，七氟烷组的早期恢复也更快。在出院准备方面，七氟烷和异氟烷之间存在微小差异（5分钟），但其他麻醉剂之间无差异。与异氟烷相比，丙泊酚组的恶心、呕吐、头痛及出院后恶心呕吐发生率更低（P<0.05）。与丙泊酚组相比，吸入麻醉组需要使用止吐药的患者更多。我们得出结论，不同麻醉剂在早期恢复时间上的差异较小，且吸入麻醉剂更具优势。丙泊酚的副作用发生率，尤其是术后恶心呕吐的发生率更低。
一项对比较基于丙泊酚、异氟烷、地氟烷和七氟烷麻醉后成人术后恢复情况的文献的系统分析表明，地氟烷组和七氟烷组的早期恢复更快。丙泊酚的恶心呕吐发生率更低。
