Smith I, Ding Y, White P F
Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110.
Anesth Analg. 1992 Feb;74(2):253-9. doi: 10.1213/00000539-199202000-00015.
Induction of, maintenance of, and recovery from sevoflurane anesthesia were compared with propofol and isoflurane anesthesia when administered with nitrous oxide to patients undergoing gynecologic surgery. Seventy-five healthy (ASA I or II), consenting patients were randomly assigned to receive either (I) propofol for induction of anesthesia and isoflurane-nitrous oxide for maintenance (control), (II) propofol for induction and sevoflurane-nitrous oxide for maintenance, or (III) sevoflurane-nitrous oxide for induction and maintenance of anesthesia. Inhaled induction of anesthesia with sevoflurane-nitrous oxide was rapid (109 +/- 25 s to loss of consciousness) and without any untoward hemodynamic changes or episodes of coughing and laryngospasm. Mean arterial blood pressure after induction of anesthesia with propofol (71 +/- 11, 73 +/- 12 mm Hg for groups I and II, respectively) was lower than when sevoflurane (80 +/- 14 mm Hg) was used. The emergence time after discontinuation of isoflurane-nitrous oxide (6.7 +/- 2.2 min) was significantly longer than after propofol-sevoflurane-nitrous oxide or sevoflurane-nitrous oxide alone (4.1 +/- 2.2 and 4.0 +/- 2.0 min for groups II and III, respectively). However, later recovery events did not differ between groups. Serum fluoride levels increased after administration of sevoflurane but not isoflurane. The levels of fluoride ions correlated with the degree of exposure to sevoflurane in MAC-hours. In conclusion, induction of anesthesia with either propofol or sevoflurane-nitrous oxide was rapid and without significant side effects. Emergence and early recovery after maintenance of anesthesia with sevoflurane-nitrous oxide was significantly faster than that after an isoflurane-nitrous oxide combination.
在接受妇科手术的患者中，将七氟醚麻醉的诱导、维持及苏醒过程与丙泊酚和异氟醚麻醉（与一氧化二氮联合使用时）进行了比较。75名健康（ASA I或II级）且同意参与的患者被随机分配接受以下处理：（I）丙泊酚用于麻醉诱导，异氟醚-一氧化二氮用于维持（对照组）；（II）丙泊酚用于诱导，七氟醚-一氧化二氮用于维持；或（III）七氟醚-一氧化二氮用于麻醉诱导和维持。七氟醚-一氧化二氮吸入诱导麻醉迅速（意识消失时间为109±25秒），且无任何不良血流动力学变化或咳嗽及喉痉挛发作。丙泊酚诱导麻醉后的平均动脉血压（I组和II组分别为71±11、73±12毫米汞柱）低于使用七氟醚时（80±14毫米汞柱）。停用异氟醚-一氧化二氮后的苏醒时间（6.7±2.2分钟）显著长于丙泊酚-七氟醚-一氧化二氮或单独使用七氟醚-一氧化二氮后的苏醒时间（II组和III组分别为4.1±2.2和4.0±2.0分钟）。然而，各组后期恢复情况并无差异。七氟醚给药后血清氟化物水平升高，而异氟醚给药后未升高。氟离子水平与七氟醚的MAC-小时暴露程度相关。总之，丙泊酚或七氟醚-一氧化二氮诱导麻醉迅速且无明显副作用。七氟醚-一氧化二氮维持麻醉后的苏醒和早期恢复明显快于异氟醚-一氧化二氮联合使用后的情况。
