Sale S M, Read J A, Stoddart P A, Wolf A R
Department of Anaesthesia, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK.
Br J Anaesth. 2006 Jun;96(6):774-8. doi: 10.1093/bja/ael100. Epub 2006 Apr 28.
Formerly premature infants having inguinal herniotomy have been at a high risk of postoperative apnoea, newer less soluble anaesthetic agents may reduce this risk.
Thirty infants, under 37 weeks gestation and under 47 weeks post-conceptional age, undergoing inguinal herniotomy had an inhalational induction with sevoflurane and were randomly allocated to sevoflurane (group S) or desflurane (group D) for maintenance. All infants received i.v. atracurium 0.5 mg kg(-1), rectal acetaminophen 20 mg kg(-1) and caudal bupivacaine 0.25% 1 ml kg(-1). Infants were monitored for apnoeas (using nasal thermistry and impedance), haemoglobin oxygen desaturations and bradycardias for 12 h before and after operation with an Alice 4 polysomnograph. Emergence timings were recorded.
There was no difference between pre- and postoperative incidence of apnoeas in either group, and no group difference between desflurane and sevoflurane in terms of pre- and postoperative ventilatory events or in the number of apnoeas in the postoperative period (nine patients in group D and five patients in group S had apnoeas). Median times to first movement, tracheal extubation, eye opening and first cry were all faster with group D (group D: 3.0, 10.0, 9.0 and 11.0 min and group S: 7.0, 15.1, 13.5 and 16.1 min, respectively). No infant had problems with airway irritation on emergence and no infant required airway intervention for apnoea.
Infants wake faster from general anaesthesia when maintained with desflurane as compared with sevoflurane, but no difference in postoperative respiratory events was demonstrated between the groups.
以往接受腹股沟疝修补术的早产儿术后发生呼吸暂停的风险较高，新型低溶解度麻醉剂可能会降低这种风险。
30例孕周小于37周、孕龄小于47周且接受腹股沟疝修补术的婴儿，采用七氟醚进行吸入诱导，并随机分为七氟醚组（S组）或地氟醚组（D组）进行维持麻醉。所有婴儿均静脉注射阿曲库铵0.5mg/kg、直肠给予对乙酰氨基酚20mg/kg及骶管注射0.25%布比卡因1ml/kg。使用Alice 4多导睡眠监测仪对婴儿术前和术后12小时的呼吸暂停（采用鼻热敏法和阻抗法）、血红蛋白氧饱和度下降及心动过缓情况进行监测。记录苏醒时间。
两组术后呼吸暂停的发生率与术前相比均无差异，地氟醚组和七氟醚组在术前和术后通气事件方面或术后呼吸暂停次数方面均无组间差异（D组9例、S组5例发生呼吸暂停）。D组首次活动、气管拔管、睁眼和首次啼哭的中位时间均快于S组（D组分别为3.0、10.0、9.0和11.0分钟，S组分别为7.0、15.1、13.5和16.1分钟）。没有婴儿在苏醒时出现气道刺激问题，也没有婴儿因呼吸暂停需要气道干预。
与七氟醚相比，使用地氟醚维持麻醉时婴儿从全身麻醉中苏醒更快，但两组术后呼吸事件无差异。
