Eberhart L H J, Gerlach H, Knaber R, Koch T, Morin A M, Röhr F, Wagner S, Wulf H, Zoremba M
Klinik für Anästhesie und Intensivtherapie, Philipps-Universität Marburg, Baldingerstrasse, Marburg, Germany.
Anaesthesist. 2011 Jan;60(1):39-48. doi: 10.1007/s00101-010-1770-2. Epub 2010 Nov 11.
According to numerous pharmacoeconomic studies new anaesthesia techniques can improve recovery times and thus can have a positive economic impact on patient turnover. However, artificial study protocols do not always match real world situations and thus the practical impact of such studies remains unclear.
At 10 hospitals exclusively using sevoflurane as a volatile anaesthetic, the ad hoc implementation of desflurane was studied with respect to post-anaesthetic recovery times (primary endpoint) and postoperative outcome measured by the Quality of Recovery Score- (QoR-)40, on the first postoperative day was investigated. Randomization of patients undergoing elective surgical procedures under general anaesthesia with sevoflurane (n=186) or desflurane (n=176) was started immediately after a period of a few days after introducing the new drug to all participants. Except for the volatile anaesthetic the anaesthetic procedure was performed according to local standing operating procedures.
All parameters indicating the immediate postanaesthetic recovery were superior in the patients receiving desflurane (mean±SD). Time to extubation was accelerated from 8.7±9.7 to 6.2±6.8 min. Times to recalling name and date of birth were accelerated by 2.6 and 3.8 min, respectively. Transferring the patients from the operating theatre to the post-anaesthetic recovery unit was 17.3±11.5 min after sevoflurane and 13.7±7.8 min after anaesthesia with desflurane. Eligibility for discharge according to a modified Aldrete score (White and Song 1999) was reached after 103±98 and 79±76 min, respectively. The postoperative recovery (QoR 40 questionnaire) did not differ 24 h later.
The implementation of a new drug (here: desflurane to substitute sevoflurane) can improve speed of recovery immediately after termination of anaesthesia even after a very short period of introducing the new technique but has no positive long term effects. Thus, the results of this trial performed under a real world scenario (health service research) without tight standardization by an artificial study protocol supports the results originating from randomized controlled clinical trials.
根据众多药物经济学研究，新的麻醉技术可缩短恢复时间，从而对患者周转率产生积极的经济影响。然而，人工制定的研究方案并不总是与现实情况相符，因此此类研究的实际影响仍不明确。
在10家仅使用七氟醚作为挥发性麻醉剂的医院，研究了地氟醚的临时应用对麻醉后恢复时间（主要终点）的影响，并在术后第一天通过恢复质量评分（QoR）-40对术后结果进行了调查。在向所有参与者引入新药几天后，立即开始对接受七氟醚（n = 186）或地氟醚（n = 176）全身麻醉的择期手术患者进行随机分组。除挥发性麻醉剂外，麻醉程序均按照当地现行操作程序进行。
所有表明麻醉后即刻恢复的参数在接受地氟醚的患者中均更优（均值±标准差）。拔管时间从8.7±9.7分钟加快至6.2±6.8分钟。唤出姓名和出生日期的时间分别加快了2.6分钟和3.8分钟。七氟醚麻醉后将患者从手术室转运至麻醉后恢复室的时间为17.3±11.5分钟，地氟醚麻醉后为13.7±7.8分钟。根据改良的Aldrete评分（White和Song，1999年），分别在103±98分钟和79±76分钟后达到出院标准。24小时后的术后恢复情况（QoR 40问卷）没有差异。
新药（此处为地氟醚替代七氟醚）的应用即使在引入新技术后很短时间内，也能在麻醉结束后立即提高恢复速度，但没有长期的积极影响。因此，在现实场景（卫生服务研究）下进行的、未通过人工研究方案进行严格标准化的该试验结果，支持了来自随机对照临床试验的结果。
