Sun Mark Y, Canete Jonathan J, Friel John C, McDade Janet, Singla Sudershan, Paterson Craig A, Counihan Timothy C
Section of Colon and Rectal Surgery, University of Massachusetts Medical School, Worcester, Massachusetts 01608, USA.
Dis Colon Rectum. 2006 Jul;49(7):1059-65. doi: 10.1007/s10350-006-0572-8.
Concerns persist regarding respiratory complications from combination deep intravenous sedation and local anesthesia for prone position anorectal surgery. We examined the safety and efficacy of this approach by using a propofol-based and ketamine-based technique.
A retrospective review was conducted on all patients undergoing anorectal surgery. Outcomes (perioperative times, specific complications) were compared with respect to operative position and anesthetic approach. Significance was determined using Student's t-test and chi-squared analysis.
Surgery was performed on 448 patients during a three-year period. There was no significant difference in the two anesthetic groups with regard to age and gender. There were 19 anesthesia-related adverse events occurring in the study group (Monitored Anesthesia Care Group): nausea and vomiting (n = 8), airway obstruction necessitating conversion to general anesthesia (n = 2), excessive pain (n = 2), urinary retention (n = 5), and hospital readmission (n = 2). These occurred in <5 percent of those receiving the combination technique (19/407). Although there was no difference in total procedural time, there was a significant difference in total time spent in the operating room (P = 0.001) and in the hospital overall (P = 0.002). Of the patients receiving combination technique anesthesia, only 31 (7 percent) required the use of the postanesthesia care unit. All patients receiving general anesthesia (n = 23) required the postanesthesia care unit.
Combination deep intravenous sedation with local anesthesia based on propofol and ketamine is a safe and effective technique for prone-position anorectal surgery. It results in decreased use of the postanesthesia care unit and earlier hospital discharge, reflecting a more efficient use of hospital resources.
对于俯卧位肛肠手术联合深度静脉镇静和局部麻醉所引发的呼吸并发症，人们一直心存担忧。我们通过使用基于丙泊酚和基于氯胺酮的技术，对这种方法的安全性和有效性进行了研究。
对所有接受肛肠手术的患者进行回顾性分析。根据手术体位和麻醉方法比较结果（围手术期时间、特定并发症）。采用学生t检验和卡方分析确定显著性。
在三年期间对448例患者进行了手术。两个麻醉组在年龄和性别方面无显著差异。研究组（监测麻醉护理组）发生了19例与麻醉相关的不良事件：恶心和呕吐（n = 8）、因气道梗阻需转为全身麻醉（n = 2）、疼痛过度（n = 2）、尿潴留（n = 5）和再次入院（n = 2）。这些不良事件发生在接受联合技术的患者中不到5%（19/407）。虽然总手术时间没有差异，但在手术室的总时间（P = 0.001）和总体住院时间（P = 0.002）上存在显著差异。接受联合技术麻醉的患者中，只有31例（7%）需要使用麻醉后护理单元。所有接受全身麻醉的患者（n = 23）均需要麻醉后护理单元。
基于丙泊酚和氯胺酮的深度静脉镇静与局部麻醉联合应用是俯卧位肛肠手术的一种安全有效的技术。它减少了麻醉后护理单元的使用，并使患者更早出院，反映了医院资源的更有效利用。
