Laosuwan Surajak, Pongruekdee Sukanya, Thaharavanich Russana
Department of Anesthesiology, Charoenkrung Pracharak Hospital, Bangkok, Thailand.
J Med Assoc Thai. 2011 Aug;94(8):965-71.
Compare the efficacy of sedation of propofol infusion during spinal anesthesia between effective-site target controlled infusion and manually controlled infusion during spinal anesthesia.
Sixty inpatients scheduled for elective surgery undergoing spinal anesthesia were studied. The patients were allocated to one of two groups. Each group has 30 patients. The TCI group (n = 30) received propofol infusion using effective-site target controlled infusion. The initial target concentration of the effective site of propofol was 1.5 microg/ml. The MCI group (n = 30) received initial bolus 0.5 mg/kg and initial infusion rate 1.5 mg/kg/hr. The anesthesiologist adjusted to increase or decrease the infusion rate in both groups every minute in order to maintain the desired level of sedation (OAA/S score of 3 or 4). Hemodynamic, OAA/S score, the induction time, propofol dose, complications were recorded.
The TCI group achieved the desired level of sedation (OAA/S score 3 or 4) faster than MCI group. The patients in TCI group had sedation score < 3 more than MCI group during surgery. Mean arterial pressure of TCI group were significantly lower than the MCI group at 15, 30, 45 min. Four patients in the TCI group was experienced airway obstruction. Two patients in the TCI group aspirated saliva and choked when they were sleeping. Eight patients in the TCI group and one patient in the MCI group were restless and there were intermittent patient movements.
The clinical benefit when used for sedation during spinal anesthesia of MCI was not different from TCI. There were complications in the TCI group more than the MCI group.
比较腰麻期间有效部位靶控输注与手动控制输注丙泊酚镇静的效果。
研究60例计划接受择期手术并进行腰麻的住院患者。患者被分为两组，每组30例。靶控输注组（n = 30）采用有效部位靶控输注丙泊酚，丙泊酚有效部位的初始靶浓度为1.5微克/毫升。手动控制输注组（n = 30）给予初始负荷剂量0.5毫克/千克和初始输注速率1.5毫克/千克/小时。两组麻醉医生每分钟调整以增加或降低输注速率，以维持所需的镇静水平（OAA/S评分为3或4）。记录血流动力学、OAA/S评分、诱导时间、丙泊酚剂量、并发症。
靶控输注组比手动控制输注组更快达到所需的镇静水平（OAA/S评分为3或4）。靶控输注组患者在手术期间镇静评分<3的情况比手动控制输注组更多。靶控输注组在15、30、45分钟时的平均动脉压显著低于手动控制输注组。靶控输注组有4例患者出现气道梗阻。靶控输注组有2例患者在睡眠时唾液误吸并窒息。靶控输注组有8例患者和手动控制输注组有1例患者烦躁不安且有间歇性肢体活动。
腰麻期间用于镇静时，手动控制输注与靶控输注的临床益处无差异。靶控输注组的并发症比手动控制输注组更多。
