Sonne N M, Wegmann F, Crawford M E, Boysen K, Krintel J J, Valentin N
Department of Anesthesia, Gentofte Hospital, University of Copenhagen, Denmark.
Acta Anaesthesiol Scand. 1991 Nov;35(8):750-4. doi: 10.1111/j.1399-6576.1991.tb03384.x.
One of the major problems with total intravenous anaesthesia (TIVA) is postoperative sedation, possibly with respiratory depression. The aim of the present study was to evaluate the recovery characteristics after TIVA using a continuous infusion of a mixture of midazolam and alfentanil with flumazenil reversal before extubation. This method was compared to balanced anaesthesia using midazolam, alfentanil and nitrous oxide without flumazenil reversal. The degree of sedation was measured by reaction time test, Glasgow Coma Scale, cipher copying test and subtraction test. We found significantly faster reaction times postoperatively in the TIVA group (n = 15) compared to the balanced group (n = 13), despite larger doses of both midazolam (median 21 mg versus 9 mg) and alfentanil (median 5.9 mg versus 4.5 mg). The other tests revealed no difference between the groups. One patient became resedated after flumazenil. We conclude that the TIVA technique described here resulted in slightly better recovery characteristics, offering a usable alternative to balanced anaesthesia.
全静脉麻醉（TIVA）的主要问题之一是术后镇静，可能伴有呼吸抑制。本研究的目的是评估在拔管前使用咪达唑仑和阿芬太尼混合液持续输注并使用氟马西尼进行逆转的TIVA术后恢复特征。将该方法与使用咪达唑仑、阿芬太尼和氧化亚氮且不使用氟马西尼逆转的平衡麻醉进行比较。通过反应时间测试、格拉斯哥昏迷量表、密码抄写测试和减法测试来测量镇静程度。我们发现，与平衡麻醉组（n = 13）相比，TIVA组（n = 15）术后反应时间明显更快，尽管咪达唑仑（中位数21 mg对9 mg）和阿芬太尼（中位数5.9 mg对4.5 mg）的剂量都更大。其他测试显示两组之间没有差异。一名患者在使用氟马西尼后再次出现镇静。我们得出结论，此处描述的TIVA技术导致恢复特征稍好，为平衡麻醉提供了一种可行的替代方法。
