七氟醚-舒芬太尼复合麻醉下术中唤醒试验对青少年特发性脊柱侧凸手术的影响：一项随机研究。

Effect of the intraoperative wake-up test in sevoflurane-sufentanil combined anesthesia during adolescent idiopathic scoliosis surgery: a randomized study.

机构信息

Department of Anesthesiology, Kunming General Hospital of Chengdu Military Area, Kunming 650032, Yunnan, China.

出版信息

J Clin Anesth. 2013 Jun;25(4):263-7. doi: 10.1016/j.jclinane.2012.09.005. Epub 2013 May 7.

DOI:10.1016/j.jclinane.2012.09.005

PMID:23659825

Abstract

STUDY OBJECTIVE

To investigate the effect of the intraoperative wake-up test on sevoflurane-sufentanil anesthesia for adolescent idiopathic scoliosis (AIS) surgery.

DESIGN

Randomized, double-blind, parallel trial.

SETTING

Operating room.

PATIENTS

30 ASA physical status 1 patients, aged 13 to 20 years, scheduled for AIS surgery.

INTERVENTIONS

Patients were randomized to two groups: Group W patients received sevoflurane-sufentanil combined anesthesia and underwent the intraoperative wake-up test; Group NW received sevoflurane-sufentanil combined anesthesia without the wake-up test. Anesthesia was induced with an intravenous (IV) injection of midazolam, propofol, and sufentanil and maintained with sevoflurane inhalation, a target-controlled infusion (TCI) of sufentanil, and IV infusion of cisatracurium besylate.

MEASUREMENTS

The primary outcome was postoperative delirium. Secondary outcomes were duration of surgery, duration of anesthesia, intraoperative blood loss and transfusion, exposure of drugs administered, time to eye opening, extubation, and consciousness.

MAIN RESULTS

Postoperative delirium occurred in one patient from each group (P > 0.05). There were no significant differences between the two groups in duration of surgery (322 ± 65 min vs 336 ± 72 min), duration of anesthesia (356 ± 76 min vs 368 ± 81 min), intraoperative blood loss (1847 ± 423 mL vs 1901 ± 451 mL) and transfusion (1663 ± 398 mL vs 1649 ± 382 mL), average exposure of drugs (72 ± 13 mg vs 75 ± 15 mg for propofol, 116 ± 28 μg vs 109 ± 25 μg for sufentanil, and 22 ± 5 vs 23 ± 4 mg for cisatracurium), time to eye opening (4.7 ± 1.5 min vs 4.8 ± 1.4 min), extubation (7.5 ± 2.0 min vs 7.3 ± 2.2 min), and consciousness (8.9 ± 1.8 min vs 9.1 ± 2.1 min) (all P > 0.05).

CONCLUSIONS

Sevoflurane-sufentanil combined anesthesia provides hemodynamic stability and rapid recovery from AIS surgery. There is no correlation between the intraoperative wake-up test and postoperative delirium after sevoflurane-sufentanil combined anesthesia.

摘要

研究目的

研究术中唤醒试验对青少年特发性脊柱侧凸（AIS）手术中七氟醚-舒芬太尼麻醉的影响。

设计

随机、双盲、平行试验。

地点

手术室。

患者

30 名 ASA 体格 1 级患者，年龄 13 至 20 岁，拟行 AIS 手术。

干预措施

患者随机分为两组：W 组患者接受七氟醚-舒芬太尼复合麻醉，并进行术中唤醒试验；NW 组患者接受七氟醚-舒芬太尼复合麻醉，不进行唤醒试验。麻醉诱导采用静脉注射咪达唑仑、丙泊酚和舒芬太尼，维持采用七氟醚吸入、舒芬太尼靶控输注（TCI）和顺苯磺酸阿曲库铵静脉输注。

测量

主要结局是术后谵妄。次要结局是手术时间、麻醉时间、术中失血量和输血、药物暴露时间、睁眼时间、拔管时间和意识恢复时间。

主要结果

两组各有 1 例患者发生术后谵妄（P > 0.05）。两组手术时间（322 ± 65 min 与 336 ± 72 min）、麻醉时间（356 ± 76 min 与 368 ± 81 min）、术中失血量（1847 ± 423 mL 与 1901 ± 451 mL）和输血（1649 ± 382 mL 与 1663 ± 398 mL）、药物平均暴露量（丙泊酚 72 ± 13 mg 与 75 ± 15 mg，舒芬太尼 116 ± 28 μg 与 109 ± 25 μg，顺苯磺酸阿曲库铵 22 ± 5 与 23 ± 4 mg）、睁眼时间（4.7 ± 1.5 min 与 4.8 ± 1.4 min）、拔管时间（7.5 ± 2.0 min 与 7.3 ± 2.2 min）和意识恢复时间（8.9 ± 1.8 min 与 9.1 ± 2.1 min）差异均无统计学意义（均 P > 0.05）。