Hernández-Palazón J, Doménech-Asensi P, Burguillos-López S, Segura-Postigo B, Sánchez-Ródenas L, López-Hernández F
Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen de la Arrixaca, Murcia.
Rev Esp Anestesiol Reanim. 2006 Feb;53(2):88-94.
To compare the effectiveness of propofol versus sevoflurane associated with remifentanil on the maintenance of anesthesia and on recovery in patients undergoing elective supratentorial craniotomy.
Prospective randomized trial enrolling 90 patients scheduled for excision of a brain neoplasm. All received an infusion of remifentanil at a dose of 0.5 microg x Kg(-1) x min(-1) until tracheal intubation and then 0.25 microg x Kg(-1) x min(-1) during surgery. Induction was achieved with propofol and anesthesia was maintained with either sevoflurane at a maximum alveolar concentration of 0.4 (45 patients) or propofol by target controlled infusion at a concentration of 2.5 microg x mL(-1) (45 patients, group P). Variables assessed were hemodynamic stability during anesthesia and times and quality of recovery from anesthesia (eye opening, initiation of spontaneous ventilation, extubation, cough reflex, and temporal and spacial orientation 3 minutes after extubation. During the first 24 hours after surgery, pain intensity was evaluated on a verbal visual analog scale (VAS) and the incidence of nausea and vomiting was recorded.
Times until eye opening upon request and until extubation were significantly shorter in the sevoflurane group than in the propofol group: 3.7 (SD, 1.2) minutes vs 5 (3.1) minutes, respectively, for eye opening and 6.6 (1.2) minutes vs 8.1 (3.3) minutes for extubation (P<0.01). The incidence of nausea and vomiting was significantly higher in the sevoflurane group (40% vs 13%, respectively, P<0.01).
Combining remifentanil with propofol or with sevoflurane provides satisfactory anesthesia during elective supratentorial craniotomy to remove a brain neoplasm. Hemodynamic stability is appropriate and recovery from anesthesia is rapid.
比较丙泊酚与七氟醚联合瑞芬太尼用于择期幕上开颅手术患者麻醉维持及苏醒的效果。
前瞻性随机试验，纳入90例计划行脑肿瘤切除术的患者。所有患者在气管插管前均接受0.5μg·kg⁻¹·min⁻¹剂量的瑞芬太尼输注，手术期间为0.25μg·kg⁻¹·min⁻¹。诱导采用丙泊酚，麻醉维持采用七氟醚，最大肺泡浓度为0.4（45例患者）或丙泊酚靶控输注，浓度为2.5μg·mL⁻¹（45例患者，P组）。评估的变量包括麻醉期间的血流动力学稳定性、麻醉苏醒时间及质量（睁眼、自主呼吸恢复、拔管、咳嗽反射以及拔管后3分钟的时间和空间定向）。术后24小时内，采用言语视觉模拟评分法（VAS）评估疼痛强度，并记录恶心呕吐的发生率。
七氟醚组达到指令性睁眼及拔管的时间显著短于丙泊酚组：睁眼时间分别为3.7（标准差，1.2）分钟和5（3.1）分钟，拔管时间分别为6.6（1.2）分钟和8.1（3.3）分钟（P<0.01）。七氟醚组恶心呕吐的发生率显著高于丙泊酚组（分别为40%和13%，P<0.01）。
瑞芬太尼与丙泊酚或七氟醚联合应用于择期幕上开颅脑肿瘤切除术中可提供满意的麻醉效果。血流动力学稳定，麻醉苏醒迅速。
