Department of Anaesthesia and Intensive Care, University of Marburg, Baldingerstraße, Marburg, Germany.
Anesth Analg. 2011 Jul;113(1):63-9. doi: 10.1213/ANE.0b013e3181fdf5d4. Epub 2010 Oct 21.
In this study, we evaluated the influence of propofol versus desflurane anesthesia in overweight patients on postoperative lung function and pulse oximetry values.
We prospectively studied 134 patients with body mass indices of 25 to 35 kg/m(2) undergoing minor peripheral surgery lasting 40 to 120 minutes. Patients were randomly assigned to receive propofol (total IV anesthesia) or desflurane anesthesia via a tracheal tube targeting bispectral index values of 40 to 60. Premedication, adjuvant drug usage, and ventilation were standardized. We measured oxyhemoglobin saturation and lung function preoperatively (baseline), and at 10 minutes, 0.5 hour, 2 hours, and 24 hours after tracheal extubation. All values were measured with the patient supine, in a 30° head-up position. Changes from preoperative baseline values were first analyzed for the impact of body mass index and type of anesthesia using univariate methods, followed by linear regression and multivariate analysis of variance.
Within the first 2 hours after surgery, the propofol group displayed lower oxyhemoglobin saturation (at 2 hours, mean ± SD, 93.8% ± 2.0% vs 94.6% ± 2.1%; P < 0.007) and lung function (forced vital capacity, forced expiratory volume exhaled in 1 second [FEV(1)], peak expiratory flow, midexpiratory flow [MEF], forced inspiratory vital capacity, and peak inspiratory flow; between 11% and 20% larger reduction from baseline in the propofol group, all P < 0.001) compared with the desflurane group. Even 24 hours after surgery, FEV(1), peak expiratory flow, MEF, forced inspiratory vital capacity, and peak inspiratory flow were reduced more in the propofol group (all P < 0.01). At 2 hours after extubation, increasing obesity was associated with decreasing FEV(1) and MEF in patients anesthetized with propofol but not desflurane (P < 0.01).
We conclude that, for superficial surgical procedures of up to 120 minutes, maintenance of anesthesia with propofol impairs early postoperative lung function and pulse oximetry values more than with desflurane. Furthermore, increasing obesity decreases pulmonary function at 2 hours after propofol anesthesia but not after desflurane anesthesia.
本研究旨在评估超重患者接受异丙酚或地氟醚麻醉对术后肺功能和脉搏血氧饱和度值的影响。
我们前瞻性研究了 134 例 BMI 为 25 至 35kg/m²的患者，他们接受持续 40 至 120 分钟的小型外周手术。患者随机接受异丙酚（全凭静脉麻醉）或地氟醚麻醉，通过气管内管以双频谱指数值 40 至 60 为目标。术前、辅助药物使用和通气标准化。我们在术前（基线）、气管拔管后 10 分钟、0.5 小时、2 小时和 24 小时测量氧合血红蛋白饱和度和肺功能。所有值均在患者仰卧位、30°头高位时测量。使用单变量方法首先分析体重指数和麻醉类型对变化的影响，然后进行线性回归和多变量方差分析。
术后 2 小时内，异丙酚组的氧合血红蛋白饱和度（术后 2 小时，平均值±标准差，93.8%±2.0%比 94.6%±2.1%；P<0.007）和肺功能（用力肺活量、呼出 1 秒用力呼气量[FEV1]、呼气峰流速、中段呼气流量[MEF]、吸气用力肺活量、吸气峰流速；异丙酚组的降幅比地氟醚组大 11%至 20%，所有 P<0.001）均低于地氟醚组。甚至在手术后 24 小时，FEV1、呼气峰流速、MEF、吸气用力肺活量和吸气峰流速在异丙酚组中仍降低更多（所有 P<0.01）。气管拔管后 2 小时，肥胖程度增加与接受异丙酚麻醉的患者的 FEV1 和 MEF 降低相关，但与地氟醚麻醉无关（P<0.01）。
我们的结论是，对于持续时间不超过 120 分钟的浅表手术，异丙酚维持麻醉比地氟醚麻醉更能损害术后早期肺功能和脉搏血氧饱和度值。此外，肥胖程度增加会降低接受异丙酚麻醉后 2 小时的肺功能，但不会降低接受地氟醚麻醉后的肺功能。
