Van Hemelrijck J, Smith I, White P F
Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri 63110.
Anesthesiology. 1991 Aug;75(2):197-203. doi: 10.1097/00000542-199108000-00005.
Desflurane's induction and recovery characteristics were compared to those of propofol-nitrous oxide in outpatients undergoing laparoscopic procedures. Ninety-two healthy patients were randomized to receive either: 1) propofol induction and propofol-nitrous oxide maintenance (control), 2) propofol induction and desflurane-nitrous oxide maintenance, 3) desflurane-nitrous oxide, or 4) desflurane alone for induction and maintenance of anesthesia. Inhalation induction with desflurane-nitrous oxide was faster than with desflurane alone (100 +/- 35 vs. 124 +/- 43 s). Inhalation inductions were associated with a high incidence of apnea (17 and 26%), breath-holding (26 and 39%), and coughing (30 and 22%) in groups 3 and 4, respectively. The emergence time after discontinuation of desflurane in oxygen (4.5 +/- 2.1 min.) was significantly less than that after propofol-nitrous oxide (7.3 +/- 3.9 min.). However, times from arrival in the recovery room until the patients were judged fit for discharge were similar for all four treatment groups. Digit-symbol substitution test results and sedation visual analogue scores also were similar during the first 2 h in the recovery room. A lower incidence of moderate-to-severe nausea was reported in group 1 (15% vs. 52, 52, and 59% in groups 2, 3, and 4, respectively). In conclusion, induction of anesthesia with desflurane was rapid but is associated with a high incidence of airway irritation. Emergence and recovery profiles after maintenance of anesthesia with desflurane compared favorably to a propofol-nitrous oxide combination. However, propofol was associated with a lower incidence of nausea than was desflurane after outpatient anesthesia for laparoscopic surgery.
在接受腹腔镜手术的门诊患者中，比较了地氟烷与丙泊酚 - 氧化亚氮的诱导和恢复特征。92名健康患者被随机分为四组，分别接受：1）丙泊酚诱导及丙泊酚 - 氧化亚氮维持（对照组）；2）丙泊酚诱导及地氟烷 - 氧化亚氮维持；3）地氟烷 - 氧化亚氮；4）单纯地氟烷用于麻醉诱导和维持。地氟烷 - 氧化亚氮吸入诱导比单纯地氟烷吸入诱导更快（100±35秒对124±43秒）。在第3组和第4组中，吸入诱导分别与较高的呼吸暂停发生率（17%和26%）、屏气发生率（26%和39%）以及咳嗽发生率（30%和22%）相关。停止吸入地氟烷后在纯氧中苏醒时间（4.5±2.1分钟）显著短于丙泊酚 - 氧化亚氮组（7.3±3.9分钟）。然而，所有四个治疗组从进入恢复室到患者被判定适合出院的时间相似。在恢复室的最初2小时内，数字符号替代测试结果和镇静视觉模拟评分也相似。第1组中报告的中重度恶心发生率较低（分别为15%，而第2、3和4组分别为52%、52%和59%）。总之，地氟烷麻醉诱导迅速，但与气道刺激的高发生率相关。与丙泊酚 - 氧化亚氮联合使用相比，地氟烷维持麻醉后的苏醒和恢复情况良好。然而，在门诊腹腔镜手术麻醉后，丙泊酚引起恶心的发生率低于地氟烷。
