Friesen R H, Lockhart C H
Department of Anesthesiology, Children's Hospital, Denver, Colorado 80218.
Anesthesiology. 1992 Jan;76(1):46-51. doi: 10.1097/00000542-199201000-00007.
he safety and efficacy of oral transmucosal fentanyl citrate (OTFC) as a preanesthetic medication and the efficacy of droperidol as a prophylactic anti-emetic were evaluated in 100 children aged 2-8 yr undergoing general anesthesia for outpatient surgery. Patients were randomly assigned to one of four groups and managed in a double-blinded manner: 1) placebo lozenge 45 min preoperatively and placebo (normal saline) injected intravenously after induction of anesthesia; 2) placebo lozenge 45 min preoperatively and 50 micrograms/kg droperidol intravenously after induction; 3) 15-20 micrograms/kg OTFC lozenge 45 min preoperatively and placebo intravenously after induction; and 4) 15-20 micrograms/kg OTFC lozenge 45 min preoperatively and droperidol 50 micrograms/kg intravenously after induction. Anesthesia was induced and maintained with halothane and nitrous oxide in oxygen. Heart rate, respiratory rate, blood pressure, and hemoglobin oxygen saturation (SpO2) were monitored throughout the study. Scoring systems were used to evaluate sedation, anxiety, cooperation, and ease and quality of anesthetic induction. Emergence, recovery, and discharge times were recorded. Nausea, vomiting, and adverse effects were noted. Preoperatively, children receiving OTFC had significantly greater sedation, slower respiratory rates, lower SpO2, and less excitement during induction. Postoperative nausea and vomiting occurred significantly more frequently after OTFC than after placebo. Prophylactic droperidol did not significantly reduce the incidence of nausea and vomiting. The authors conclude that, in pediatric surgical outpatients, OTFC reliably induces preoperative sedation and facilitates inhalation induction of anesthesia, but it is associated with significant decreases in respiratory rate and SpO2 and a high incidence of postoperative nausea and vomiting that is not significantly reduced by prophylactic droperidol.
在100名年龄在2至8岁接受门诊手术全身麻醉的儿童中，评估了口服黏膜芬太尼柠檬酸盐（OTFC）作为麻醉前用药的安全性和有效性以及氟哌利多作为预防性止吐药的有效性。患者被随机分为四组之一，并采用双盲方式进行管理：1）术前45分钟给予安慰剂含片，麻醉诱导后静脉注射安慰剂（生理盐水）；2）术前45分钟给予安慰剂含片，诱导后静脉注射50微克/千克氟哌利多；3）术前45分钟给予15 - 20微克/千克OTFC含片，诱导后静脉注射安慰剂；4）术前45分钟给予15 - 20微克/千克OTFC含片，诱导后静脉注射50微克/千克氟哌利多。使用氟烷和一氧化二氮-氧气混合气体诱导和维持麻醉。在整个研究过程中监测心率、呼吸频率、血压和血红蛋白氧饱和度（SpO2）。采用评分系统评估镇静、焦虑、合作程度以及麻醉诱导的难易程度和质量。记录苏醒、恢复和出院时间。记录恶心、呕吐和不良反应。术前，接受OTFC的儿童在诱导期间镇静作用明显更强、呼吸频率更慢、SpO2更低且兴奋程度更低。术后恶心和呕吐在接受OTFC治疗后比接受安慰剂治疗后明显更频繁地发生。预防性使用氟哌利多并未显著降低恶心和呕吐的发生率。作者得出结论，在小儿外科门诊患者中，OTFC能可靠地诱导术前镇静并促进吸入麻醉诱导，但它与呼吸频率和SpO2的显著降低以及术后恶心和呕吐的高发生率相关，预防性使用氟哌利多并不能显著降低其发生率。
