Salonia Andrea, Suardi Nazareno, Crescenti Antonella, Colombo Renzo, Rigatti Patrizio, Montorsi Francesco
Department of Urology, University Vita--Salute San Raffaele, Scientific Institute H. San Raffaele, Milan, Italy.
Int J Urol. 2006 Sep;13(9):1185-90. doi: 10.1111/j.1442-2042.2006.01524.x.
To assess the impact of spinal anesthesia (SpA) combined with three different forms of conscious sedation on intraoperative and postoperative outcome in patients undergoing radical retropubic prostatectomy (RRP) for organ confined prostate cancer (pCa).
A total of 121 consecutive patients with pCa undergoing RRP were randomized into four groups. They were randomized as follows: group 1 (general anesthesia: 34 patients), group 2 (lumbar 2 to lumbar 3 interspace SpA with diazepam as sedative agent: 28), group 3 (SpA with propofol: 30), and group 4 (SpA with midazolam: 29). Intraoperative and perioperative parameters were collected.
The present study showed that muscle relaxation throughout RRP was not different in the four groups; bleeding was significantly (P = 0.04) lower with SpA, regardless of the form of sedation. Group 3 patients reported the best postoperative oxygen saturation percentage by pulse oximetry and sedation score (P = 0.02; d.f. = 3 and P < 0.0001; d.f. = 3, respectively), the shortest waiting time in the postoperative holding area (P < 0.001; d.f. = 3), the lowest pain on postoperative day 1 (P = 0.0004; d.f. = 3), and the highest frequency of first flatus passage (P = 0.0001; d.f. = 3). A higher number of group 4 patients were able to carry out unassisted ambulation (P < 0.0001; d.f. = 3).
Conscious sedation coupled with SpA is a safe, reliable and effective procedure for patients undergoing RRP. The use of propofol as sedative agent offers several advantages both over other types of conscious sedation and general anesthesia.
评估脊髓麻醉（SpA）联合三种不同形式的清醒镇静对接受根治性耻骨后前列腺切除术（RRP）治疗局限性前列腺癌（pCa）患者的术中及术后结局的影响。
总共121例连续接受RRP治疗的pCa患者被随机分为四组。随机分组如下：第1组（全身麻醉：34例患者），第2组（腰2至腰3间隙SpA联合地西泮作为镇静剂：28例），第3组（SpA联合丙泊酚：30例），第4组（SpA联合咪达唑仑：29例）。收集术中及围手术期参数。
本研究表明，在整个RRP过程中，四组的肌肉松弛情况无差异；无论镇静形式如何，SpA组的出血量显著更低（P = 0.04）。第3组患者通过脉搏血氧饱和度测定的术后氧饱和度百分比和镇静评分最佳（分别为P = 0.02；自由度 = 3和P < 0.0001；自由度 = 3），在术后等待区的等待时间最短（P < 0.001；自由度 = 3），术后第1天疼痛最轻（P = 0.0004；自由度 = 3），首次排气频率最高（P = 0.0001；自由度 = 3）。第4组中能够独立行走的患者数量更多（P < 0.0001；自由度 = 3）。
清醒镇静联合SpA对于接受RRP的患者是一种安全、可靠且有效的方法。丙泊酚作为镇静剂的使用相较于其他类型的清醒镇静和全身麻醉具有若干优势。
