Walldén Jakob, Thörn Sven-Egron, Lövqvist Asa, Wattwil Lisbeth, Wattwil Magnus
Department of Anesthesia, Sundsvall Hospital, 851 86, Sundsvall, Sweden.
J Anesth. 2006;20(4):261-7. doi: 10.1007/s00540-006-0436-3.
A postoperative decrease in the gastric emptying (GE) rate may delay the early start of oral feeding and alter the bioavailability of orally administered drugs. The aim of this study was to compare the effect on early gastric emptying between two anesthetic techniques.
Fifty patients (age, 19-69 years) undergoing day-case laparoscopic cholecystectomy were randomly assigned to received either total intravenous anesthesia with propofol/remifentanil/rocuronium (TIVA; n = 25) or inhalational opioid-free anesthesia with sevoflurane/rocuronium (mask induction; GAS; n = 25). Postoperative gastric emptying was evaluated by the acetaminophen method. After arrival in the recovery unit, acetaminophen (paracetamol) 1.5 g was given through a nasogastric tube, and blood samples were drawn during a 2-h period. The area under the serum-acetaminophen concentration curve from 0-60 min (AUC60), the maximal concentration (Cmax), and the time to reach C-max (Tmax) were calculated.
Twelve patients were excluded due to surgical complications (e.g., conversion to open surgery) and difficulty in drawing blood samples (TIVA, n = 7; GAS, n = 5). Gastric emptying parameters were (mean +/- SD): TIVA, AUC60, 2458 +/- 2775 min.micromol.l(-1); Cmax, 71 +/- 61 micromol.l(-1); and Tmax, 81 +/- 37 min; and GAS, AUC60, 2059 +/- 2633 min.micromol.l(-1); Cmax, 53 +/- 53 micromol.l(-1); and Tmax, 83 +/- 41 min. There were no significant differences between groups.
There was no major difference in early postoperative gastric emptying between inhalation anesthesia with sevoflurane versus total intravenous anesthesia with propofol-remifentanil. Both groups showed a pattern of delayed gastric emptying, and the variability in gastric emptying was high. Perioperative factors other than anesthetic technique may have more influence on gastric emptying.
术后胃排空（GE）率降低可能会延迟早期经口喂养的开始，并改变口服药物的生物利用度。本研究的目的是比较两种麻醉技术对早期胃排空的影响。
50例（年龄19 - 69岁）接受日间腹腔镜胆囊切除术的患者被随机分配接受丙泊酚/瑞芬太尼/罗库溴铵全静脉麻醉（TIVA；n = 25）或七氟醚/罗库溴铵无吸入性阿片类药物麻醉（面罩诱导；GAS；n = 25）。采用对乙酰氨基酚法评估术后胃排空情况。到达恢复室后，通过鼻胃管给予对乙酰氨基酚（扑热息痛）1.5 g，并在2小时内采集血样。计算0 - 60分钟血清对乙酰氨基酚浓度曲线下面积（AUC60）、最大浓度（Cmax）以及达到Cmax的时间（Tmax）。
12例患者因手术并发症（如转为开放手术）和采血困难被排除（TIVA组，n = 7；GAS组，n = 5）。胃排空参数为（均值±标准差）：TIVA组，AUC60为2458±2775分钟·微摩尔·升⁻¹；Cmax为71±61微摩尔·升⁻¹；Tmax为81±37分钟；GAS组，AUC60为2059±2633分钟·微摩尔·升⁻¹；Cmax为53±53微摩尔·升⁻¹；Tmax为83±41分钟。两组之间无显著差异。
七氟醚吸入麻醉与丙泊酚 - 瑞芬太尼全静脉麻醉在术后早期胃排空方面无重大差异。两组均表现出胃排空延迟的模式，且胃排空的变异性较高。除麻醉技术外，围手术期因素可能对胃排空有更大影响。
