Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Contraception. 2013 Jan;87(1):55-62. doi: 10.1016/j.contraception.2012.08.014. Epub 2012 Sep 17.
This prospective study compared the safety, recovery time and side effects of six distinct general anesthesia regimens for first-trimester surgical abortion.
Two hundred forty women scheduled for surgical abortion at 6 to 8 weeks of gestation were randomized into three groups (n=40) of propofol: group P (2 mg/kg propofol alone), group PF (2 mg/kg propofol+1 mcg/kg fentanyl), group PMF (2 mg/kg propofol+1 mcg/kg fentanyl+0.02 mg/kg midazolam) and three groups (n=40) of etomidate: group E (0.2 mg/kg etomidate alone), group EF (0.2 mg/kg etomidate+1 mcg/kg fentanyl) and group EMF (0.2 mg/kg etomidate+1 mcg/kg fentanyl+0.02 mg/kg midazolam). Vital signs including pulse oxygen saturation (SpO2), mean arterial pressure (MAP) and heart rate were recorded as the primary outcomes. The recovery time and side effects were recorded as secondary outcomes.
During induction, SpO2 and MAP decreased significantly in all the three groups of propofol and were significantly lower than those in the groups of etomidate. Mean recovery times to both eye opening and to obeying commands were significantly shorter in group PF than those in groups P and PMF, while there were no significant differences among the three groups of etomidate. Compared with the etomidate groups, the incidence of injection-induced pain was significantly higher, while the scores of myoclonus and postoperative nausea and vomiting were lower, in the three propofol groups. Moreover, myoclonus scores as well as nausea and vomiting scores were lower in group EMF than in groups E and EF.
The results of this study suggest that (a) etomidate is much safer than propofol for first-trimester surgical abortions and (b) using a lower dose of etomidate, supplemented with fentanyl and midazolam, is more beneficial than the use of etomidate with or without fentanyl in reducing adverse effects like myoclonus and postoperative nausea and vomiting.
本前瞻性研究比较了六种不同全身麻醉方案用于孕 6-8 周早期妊娠手术流产的安全性、恢复时间和副作用。
240 名计划在孕 6-8 周行手术流产的妇女被随机分为三组（每组 40 例），分别接受不同药物：丙泊酚组（2mg/kg 丙泊酚）、丙泊酚+芬太尼组（2mg/kg 丙泊酚+1μg/kg 芬太尼）、丙泊酚+咪达唑仑组（2mg/kg 丙泊酚+1μg/kg 芬太尼+0.02mg/kg 咪达唑仑）；依托咪酯组（0.2mg/kg 依托咪酯）、依托咪酯+芬太尼组（0.2mg/kg 依托咪酯+1μg/kg 芬太尼）、依托咪酯+芬太尼+咪达唑仑组（0.2mg/kg 依托咪酯+1μg/kg 芬太尼+0.02mg/kg 咪达唑仑）。记录生命体征（脉搏血氧饱和度（SpO2）、平均动脉压（MAP）和心率）作为主要结局，记录恢复时间和副作用作为次要结局。
诱导时，三组丙泊酚组的 SpO2 和 MAP 均显著下降，且明显低于依托咪酯组。丙泊酚+芬太尼组（PF 组）的睁眼时间和听从指令时间均显著短于丙泊酚组（P 组和 PMF 组），而依托咪酯三组之间无显著差异。与依托咪酯组相比，丙泊酚三组的注射痛发生率明显更高，而肌阵挛和术后恶心呕吐的评分则更低。此外，丙泊酚+芬太尼+咪达唑仑组（EMF 组）的肌阵挛和恶心呕吐评分均低于丙泊酚+芬太尼组（E 组和 EF 组）。
本研究结果表明：（a）与丙泊酚相比，依托咪酯用于孕早期手术流产更安全；（b）与单独使用依托咪酯或依托咪酯联合芬太尼相比，使用低剂量依托咪酯，联合芬太尼和咪达唑仑，更有利于减少肌阵挛和术后恶心呕吐等不良反应。
