丙泊酚-氧化亚氮麻醉与硫喷妥钠-异氟烷-氧化亚氮麻醉在麻醉及恢复方面的差异成本

The differential cost of anesthesia and recovery with propofol-nitrous oxide anesthesia versus thiopental sodium-isoflurane-nitrous oxide anesthesia.

作者信息

Sung Y F, Reiss N, Tillette T

机构信息

Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA.

出版信息

J Clin Anesth. 1991 Sep-Oct;3(5):391-4. doi: 10.1016/0952-8180(91)90182-m.

DOI:10.1016/0952-8180(91)90182-m

PMID:1931064

Abstract

STUDY OBJECTIVE

To assess the recovery room profile of propofol in outpatient anesthesia and to compare it to the profile of a standard technique.

DESIGN

A comparative, randomized, double-blind, third-party open study.

SETTING

Ambulatory Surgery Center at The Emory Clinic.

PATIENTS

Ninety-nine ASA physical status I, II, or III nonpregnant female patients who had been diagnosed as needing breast biopsies.

INTERVENTIONS

All patients were given 1 microgram/kg of fentanyl prior to induction. Those in the propofol group were induced with 2.0 to 2.5 mg/kg of propofol and maintained with a 100 to 200 microgram/kg/min infusion of propofol with nitrous oxide (N2O) in oxygen (O2). In the thiopental sodium-isoflurane group, patients were induced with 4.0 to 5.0 mg/kg of thiopental sodium and maintained with isoflurane and N2O in O2.

MEASUREMENTS AND MAIN RESULTS

Recovery from anesthesia was assessed by an evaluator who was unaware of the anesthetic technique used for each patient. Immediate recovery time was measured in terms of awakening, response to verbal command, and orientation to time and place. A brief postoperative follow-up questionnaire was completed to assess the patients' subjective feelings regarding their ability to eat, concentrate, and resume normal activities. In the thiopental sodium-isoflurane group, 15 of 50 patients (30%) had nausea and vomiting, but in the propofol group, only 4 of 49 patients (8.1%) had nausea and vomiting (p less than 0.01). The latter group resumed normal activity (i.e., reading and watching television) 7.93 +/- 0.76 hours postanesthesia, whereas the thiopental sodium-isoflurane group resumed normal activity 17.02 +/- 1.21 hours postanesthesia (p less than 0.001). Patients in the propofol group returned to work in an average of 1.5 +/- 0.09 days, compared with 2.0 +/- 0.09 days for the thiopental sodium-isoflurane group (p less than 0.001).

CONCLUSIONS

The propofol group needed less nursing care and returned to more productive activity earlier than did the thiopental sodium-isoflurane group.

摘要

研究目的

评估丙泊酚在门诊麻醉中的恢复室情况，并与标准技术的情况进行比较。

设计

一项对比、随机、双盲、第三方开放研究。

地点

埃默里诊所门诊手术中心。

患者

99例ASA身体状况为I、II或III级的非妊娠女性患者，她们被诊断需要进行乳房活检。

干预措施

所有患者在诱导前均给予1微克/千克芬太尼。丙泊酚组患者用2.0至2.5毫克/千克丙泊酚诱导，并以100至200微克/千克/分钟的丙泊酚与氧气中的一氧化二氮（N₂O）持续输注维持麻醉。硫喷妥钠-异氟烷组患者用4.0至5.0毫克/千克硫喷妥钠诱导，并以异氟烷和氧气中的N₂O维持麻醉。

测量指标及主要结果

由一名不知道每位患者所采用麻醉技术的评估者评估麻醉恢复情况。即时恢复时间通过苏醒、对言语指令的反应以及对时间和地点的定向来衡量。完成一份简短的术后随访问卷，以评估患者对进食、集中注意力和恢复正常活动能力的主观感受。硫喷妥钠-异氟烷组50例患者中有15例（30%）出现恶心和呕吐，但丙泊酚组49例患者中只有4例（8.1%）出现恶心和呕吐（p<0.01）。后一组在麻醉后7.93±0.76小时恢复正常活动（即阅读和看电视），而硫喷妥钠-异氟烷组在麻醉后17.02±1.21小时恢复正常活动（p<0.001）。丙泊酚组患者平均在1.5±0.09天恢复工作，而硫喷妥钠-异氟烷组为2.0±0.09天（p<0.001）。