Gupta Lokesh, Sinha Sk, Pande Maitree, Vajifdar Homay
Senior Resident, Department of Anaesthesiology, Lady Hardinge Medical College, New Delhi, India.
J Anaesthesiol Clin Pharmacol. 2011 Jan;27(1):97-100.
To compare the anaesthetic techniques for laparoscopic tubal ligation using either general anaesthesia with LMA or a combination of local anaesthetic and intravenous sedation, this study was conducted on 60 ASA-1/2 patients in the age group of 20-40 years. PATIENTS #ENTITYSTARTX00026;
60 ASA grade I & II female patients undergoing laparoscopic tubal ligation on a day care basis were randomly divided in two groups- group I (GA using LMA, n=30), group II (Local anaesthesia, n=30). Both groups received similar premedication. General anaesthesia in group I was induced with propofol 2-3 mg kg(-1) and following LMA insertion, the anaesthesia was maintained with 0.5-1.5% halothane. In group II the incision site was infiltrated with 10 ml of 1.5% lidocaine with adrenaline and patients were sedated with intravenous midazolam 0.07mg kg(-1) and ketamine 0.5 mg kg(-1). A rescue dose of 0.15 mg kg(-1) of ketamine was given in group II if the patient complained of pain or discomfort during the procedure. Diclofenac sodium 1 mg kg(-1) was used for postoperative analgesia in both the groups. All patients were observed in the PACU until they met the discharge criteria.
The demographic profile was similar in both the groups. The induction to skin incision time was significantly more in group I (5.13 ±0.93 min vs 3.01 ±1.86 min in group II). The decrease in pulse rate and blood pressure (systolic and diastolic) was also significant in group I. The incidence of intraoperative bradycardia was 16.7% and 10% in group I & group II respectively. The changes in SpO(2) during the procedure, recovery time and time to meet discharge criteria were comparable in both the groups. The incidence of PONV was 20% & 3.3% in group I and 10% & 6.6% in group II respectively. All patients in both the groups required postoperative analgesics.
Both the techniques were found to be comparable for laparoscopic sterilization, however a longer induction to skin incision time and higher incidence of PONV and shivering in GA group makes LA with sedation a better choice.
为比较使用喉罩全麻与局部麻醉联合静脉镇静用于腹腔镜输卵管结扎术的麻醉技术，本研究纳入了60例年龄在20 - 40岁的ASA-1/2级患者。
60例日间行腹腔镜输卵管结扎术的ASA I级和II级女性患者被随机分为两组——I组（使用喉罩全麻，n = 30），II组（局部麻醉，n = 30）。两组患者均接受相似的术前用药。I组全麻诱导使用丙泊酚2 - 3mg·kg⁻¹，插入喉罩后，用0.5 - 1.5%的氟烷维持麻醉。II组在切口部位注射10ml含肾上腺素的1.5%利多卡因，患者静脉注射咪达唑仑0.07mg·kg⁻¹和氯胺酮0.5mg·kg⁻¹进行镇静。若II组患者在手术过程中主诉疼痛或不适，则给予0.15mg·kg⁻¹的氯胺酮抢救剂量。两组均使用双氯芬酸钠1mg·kg⁻¹进行术后镇痛。所有患者在麻醉后恢复室观察直至达到出院标准。
两组患者的人口统计学特征相似。I组诱导至皮肤切开时间显著长于II组（5.13±0.93分钟 vs II组的3.01±1.86分钟）。I组患者的心率及血压（收缩压和舒张压）下降也较为显著。I组和II组术中心动过缓的发生率分别为16.7%和10%。两组患者手术过程中的SpO₂变化、恢复时间及达到出院标准的时间相当。I组术后恶心呕吐（PONV）的发生率分别为20%和3.3%，II组分别为10%和6.6%。两组所有患者均需要术后镇痛。
两种技术用于腹腔镜绝育术效果相当，但全麻组诱导至皮肤切开时间更长，PONV发生率及寒战发生率更高，因此局部麻醉联合镇静是更好的选择。
