长时间腹腔镜手术中微流量地氟醚麻醉的安全性和有效性。

The safety and efficacy of minimal-flow desflurane anesthesia during prolonged laparoscopic surgery.

机构信息

Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea.

出版信息

Korean J Anesthesiol. 2012 Dec;63(6):498-503. doi: 10.4097/kjae.2012.63.6.498. Epub 2012 Dec 14.

DOI:10.4097/kjae.2012.63.6.498

PMID:23277809

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3531527/

Abstract

BACKGROUND

Minimal-flow anesthesia can meet the demands of a modern society that is more sensitive to environmental protection and economic burdens. This study compared the safety and efficacy of minimal-flow desflurane anesthesia with conventional high-flow desflurane anesthesia for prolonged laparoscopic surgery.

METHODS

Forty-six male patients (ASA physical status II or III) undergoing laparoscopic urologic surgery for more than 6 hours were randomly divided into two groups: the high-flow (HF) group and the minimal-flow (MF) group. The HF group was continuously administered a fresh gas flow of 4 L/min. In the MF group, a fresh gas flow of 4 L/min was administered for the first 20 minutes and was thereafter lowered to 0.5 L/min. Inspiratory and expiratory desflurane concentrations, respiratory variables, and hemodynamic variables were continuously monitored during administration of anesthesia. Measurements of carboxyhemoglobin (COHb) concentration and arterial blood gas analysis were performed every 2 hours during anesthesia. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN) and creatinine were measured on the first and second day after the surgery.

RESULTS

Demographic data and duration of anesthesia were not different between the two groups. Significant differences were not observed between the two groups in terms of hemodynamic variables, respiratory variables, and inspiratory and expiratory desflurane concentrations. Inspiratory O(2) concentration was maintained lower in the MF group than in the HF group (43-53% vs. 53-59%; P < 0.05). Compared with the HF group, COHb concentrations was higher (P < 0.05), but not increased from the baseline value in the MF group. Serum AST, ALT, BUN, and creatinine were not significantly different between the two groups.

CONCLUSIONS

In prolonged laparoscopic surgery, no significant differences were found in safety and efficacy between minimal-flow and high-flow desflurane anesthesia.

摘要

背景

最小流量麻醉可以满足对环境保护和经济负担更为敏感的现代社会的需求。本研究比较了长时间腹腔镜手术中最小流量地氟醚麻醉与常规高流量地氟醚麻醉的安全性和有效性。

方法

46 名男性患者（ASA 身体状况 II 或 III 级）接受腹腔镜泌尿科手术超过 6 小时，随机分为两组：高流量（HF）组和最小流量（MF）组。HF 组持续给予 4 L/min 的新鲜气流。在 MF 组，前 20 分钟给予 4 L/min 的新鲜气流，然后降至 0.5 L/min。麻醉期间连续监测吸入和呼出地氟醚浓度、呼吸变量和血液动力学变量。麻醉期间每 2 小时测量一次碳氧血红蛋白（COHb）浓度和动脉血气分析。术后第 1 天和第 2 天测量血清天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、血尿素氮（BUN）和肌酐。

结果

两组患者的人口统计学数据和麻醉持续时间无差异。两组患者的血液动力学变量、呼吸变量和吸入及呼出地氟醚浓度均无显著差异。MF 组的吸入 O2 浓度低于 HF 组（43-53%比 53-59%；P<0.05）。与 HF 组相比，MF 组的 COHb 浓度更高（P<0.05），但未高于基线值。两组患者的血清 AST、ALT、BUN 和肌酐均无显著差异。