Bortone Luciano, Ingelmo Pablo, Grossi Silvia, Grattagliano Cosimo, Bricchi Cristina, Barantani Daniele, Sani Emanuele, Mergoni Mario
Primo Servizio di Anestesia e Rianimazione, Azienda Ospedaliera di Parma, Parma, Italy.
Paediatr Anaesth. 2006 Nov;16(11):1138-43. doi: 10.1111/j.1460-9592.2006.01954.x.
This randomized, double-blind controlled trial was conducted to determine whether the association of sevoflurane for induction and isoflurane for anesthesia maintenance resulted in a lower incidence of postoperative agitation compared with sevoflurane as single agent.
After Institute Ethics Committee's approval and parental written informed consent, 128 unpremedicated children (1-6 years), ASA I-II, scheduled for elective subumbilical surgery were enrolled. After induction with 8% sevoflurane, patients were randomly allocated to receive sevoflurane or isoflurane 1-1.5 MAC as maintenance agent. The primary endpoint of the study was the incidence of postoperative agitation defined as a screaming and crying child and/or a child that required physical restraint during emergence.
Eighteen children were excluded because they received sedatives, analgesia or anesthesia or because of ineffective regional analgesia before randomization. Fifty-four patients receiving sevoflurane and 56 receiving isoflurane completed the study. Twenty-eight children (95% CI 38-66%) in the sevoflurane group presented with postoperative agitation compared with 18 (95% CI 20-46%) patients receiving isoflurane (P = 0.028). Fifteen minutes after awakening, 11/54 children receiving sevoflurane were agitated compared with 4/56 receiving isoflurane (P = 0.03). Thereafter, there was a gradual reduction in the incidence of postoperative agitation over time.
The association of sevoflurane for induction and isoflurane for maintenance produced significant less postoperative agitation in preschool children receiving regional anesthesia during subumbilical surgery compared with sevoflurane for induction and maintenance.
本随机双盲对照试验旨在确定与单一使用七氟醚相比，诱导期使用七氟醚并维持期使用异氟醚是否能降低术后躁动的发生率。
经机构伦理委员会批准并获得家长书面知情同意后，纳入128例未使用术前药的1-6岁、ASA I-II级、计划行择期脐下手术的儿童。用8%七氟醚诱导后，患者被随机分配接受七氟醚或1-1.5 MAC异氟醚作为维持麻醉药。研究的主要终点是术后躁动的发生率，术后躁动定义为在苏醒期哭闹尖叫的儿童和/或需要身体约束的儿童。
18例儿童被排除，原因是他们在随机分组前接受了镇静药、镇痛药或麻醉药，或区域镇痛无效。54例接受七氟醚和56例接受异氟醚的患者完成了研究。七氟醚组28例儿童（95%CI 38-66%）出现术后躁动，而异氟醚组为18例（95%CI 20-46%）患者（P = 0.028）。苏醒后15分钟，接受七氟醚的54例儿童中有11例躁动，接受异氟醚的56例儿童中有4例躁动（P = 0.03）。此后，术后躁动的发生率随时间逐渐降低。
与诱导和维持均使用七氟醚相比，诱导期使用七氟醚并维持期使用异氟醚在接受脐下手术区域麻醉的学龄前儿童中产生的术后躁动明显更少。
