Erk Gulcan, Erdogan Gulay, Sahin Fazilet, Taspinar Vildan, Dikmen Bayazit
Ankara Numune Training and Research National Hospital, Ankara, Turkey.
Middle East J Anaesthesiol. 2007 Oct;19(3):553-62.
Laparoscopic techniques, have rapidly increased in popularity because of its various benefits. They are widely used in day-case surgical operations and are extensively published. However, postoperative nausea vomiting (PONV) is a commonly observed phenomenon after laparoscopic procedures. Its occurrence may increase depending on the anesthetic techniques used. Despite the fact that the use of propofol and the new low solubility inhalation anesthetics, lead to faster induction and recovery, their effects on PONV is not sufficiently known. Therefore, the aim of this study is to compare the effects of various anesthetic drugs on recovery characteristics and PONV. Following informed consent, 300 ASA I-III patients scheduled for laparoscopic cholecystectomy were investigated. Anesthesia was induced by 1.5 microgkg(-1) fentanyl, 0.03 mgkg(-1) midazolam, 1.5 mgkg(-1) propofol and 0.01 mgkg(-1) vecuronium for all patients. Anesthesia was maintained with desflurane in group D (n = 100), sevoflurane in group S (n = 100) and propofol infusion in group P (n = 100), beside 50% N20/O2 ventilation. All patients were given 4 mg ondansetron and 8 mg dexamethazone iv for preventing PONV, ten minutes before the end of surgery. At the end of the operation, times for extubation, eye opening, orientation, sitting and walking, and the need of ondansetrone in post anesthetic care unit, were recorded. Also, PONV was observed and recorded as early period (first 4 hours) and late period (4-24 hours). Extubation and eye opening times were meaningfully lower in group D. However, no significant differences were observed in orientation, sitting and walking times and PONV among the three groups. All patients who had PONV were women. A correlation was found between PONV and body weight. Even though there were no statistically significant differences among the groups regarding PONV, the number of patients who had PONV in group P was lower. Early recovery time was shortest in group D, while delayed recovery time had no differences. It may be said that these anesthetic drugs have no statistically significant difference for PONV and delayed recovery.
腹腔镜技术因其诸多益处而迅速普及。它们广泛应用于日间手术操作，且有大量相关文献发表。然而，术后恶心呕吐（PONV）是腹腔镜手术后常见的现象。其发生率可能因所采用的麻醉技术而增加。尽管丙泊酚和新型低溶解度吸入麻醉剂的使用可导致更快的诱导和苏醒，但其对PONV的影响尚不完全清楚。因此，本研究的目的是比较各种麻醉药物对恢复特征和PONV的影响。在获得知情同意后，对300例计划行腹腔镜胆囊切除术的美国麻醉医师协会（ASA）I - III级患者进行了研究。所有患者均采用1.5μg/kg（-1）芬太尼、0.03mg/kg（-1）咪达唑仑、1.5mg/kg（-1）丙泊酚和0.01mg/kg（-1）维库溴铵诱导麻醉。D组（n = 100）用地氟烷维持麻醉，S组（n = 100）用七氟烷维持麻醉，P组（n = 100）用丙泊酚输注维持麻醉，同时给予50% N20/O2通气。所有患者在手术结束前10分钟静脉注射4mg昂丹司琼和8mg地塞米松以预防PONV。手术结束时，记录拔管时间、睁眼时间、定向力恢复时间、坐起和行走时间，以及麻醉后护理单元中昂丹司琼的使用需求。此外，观察并记录PONV的早期（前4小时）和晚期（4 - 24小时）情况。D组的拔管和睁眼时间明显更短。然而，三组在定向力恢复时间、坐起和行走时间以及PONV方面未观察到显著差异。所有发生PONV的患者均为女性。发现PONV与体重之间存在相关性。尽管三组在PONV方面无统计学显著差异，但P组发生PONV的患者数量较少。D组的早期恢复时间最短，而延迟恢复时间无差异。可以说，这些麻醉药物在PONV和延迟恢复方面无统计学显著差异。
