Sneyd J R, Andrews C J H, Tsubokawa T
Peninsula Medical School, C310 Portland Square, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK.
Br J Anaesth. 2005 Jun;94(6):778-83. doi: 10.1093/bja/aei141. Epub 2005 Apr 15.
Propofol and sevoflurane are suitable agents for maintenance of anaesthesia during neurosurgical procedures. We have prospectively compared these agents in combination with the short-acting opioid, remifentanil.
Fifty unpremedicated patients undergoing elective craniotomy received remifentanil 1 microg kg(-1) followed by an infusion commencing at 0.5 microg kg(-1) min(-1) reducing to 0.25 microg kg(-1) min(-1) after craniotomy. Anaesthesia was induced with propofol, and maintained with either a target-controlled infusion of propofol, minimum target 2 microg ml(-1) or sevoflurane, initial concentration 2%(ET). Episodes of mean arterial pressure (MAP) more than 100 mm Hg or less than 60 mm Hg for more than 1 min were defined as hypertensive or hypotensive events, respectively. A surgical assessment of operating conditions and times to spontaneous respiration, extubation, obey commands and eye opening were recorded. Drug acquisition costs were calculated.
Twenty-four and twenty-six patients were assigned to propofol (Group P) and sevoflurane anaesthesia (Group S), respectively. The number of hypertensive events was comparable, whilst more hypotensive events were observed in Group S than in Group P (P=0.053, chi-squared test). As rescue therapy, more labetolol [45 (33) vs 76 (58) mg, P=0.073] and ephedrine [4.80 (2.21) vs 9.78 (5.59) mg, P=0.020] were used in Group S. Between group differences in recovery times were small and clinically unimportant. The combined hourly acquisition costs of hypnotic, analgesic, and vasoactive drugs appeared to be lower in patients maintained with sevoflurane than with propofol.
Propofol/remifentanil and sevoflurane/remifentanil both provided satisfactory anaesthesia for intracranial surgery.
丙泊酚和七氟醚是神经外科手术中维持麻醉的合适药物。我们前瞻性地比较了这些药物与短效阿片类药物瑞芬太尼联合使用的情况。
50例未接受术前用药的择期开颅手术患者，先静脉注射瑞芬太尼1μg/kg，随后以0.5μg·kg-1·min-1的速度开始输注，开颅术后减至0.25μg·kg-1·min-1。采用丙泊酚诱导麻醉，然后用目标浓度控制输注丙泊酚（最低目标浓度2μg/ml）或七氟醚（初始浓度2%）维持麻醉。平均动脉压（MAP）超过100mmHg或低于60mmHg持续超过1分钟的情况分别定义为高血压或低血压事件。记录手术操作条件评估结果以及自主呼吸恢复时间、拔管时间、能听从指令时间和睁眼时间。计算药物购置成本。
分别有24例和26例患者被分配至丙泊酚组（P组）和七氟醚麻醉组（S组）。高血压事件的数量相当，但S组观察到的低血压事件比P组多（P = 0.053，卡方检验）。作为抢救治疗，S组使用了更多的拉贝洛尔[45（33）mg对76（58）mg，P = 0.073]和麻黄碱[4.80（2.21）mg对9.78（5.59）mg，P = 0.020]。两组之间恢复时间的差异较小，在临床上无重要意义。七氟醚维持麻醉的患者中，催眠药、镇痛药和血管活性药物的每小时联合购置成本似乎低于丙泊酚维持麻醉的患者。
丙泊酚/瑞芬太尼和七氟醚/瑞芬太尼均为颅内手术提供了满意的麻醉效果。
