Tantry Thrivikrama Padur, Muralishankar Bg, Adappa Karunakara Kenjar, Bhandary Sudarshan, Shetty Pramal, Shenoy Sunil P
Department of Anaesthesiology, A J Institute of Medical Sciences, Kuntikana, Mangalore, Karnataka, India.
Indian J Anaesth. 2013 Jan;57(1):35-40. doi: 10.4103/0019-5049.108559.
One of the challenges of anaesthesia for shoulder arthroscopic procedures is the need for controlled hypotension to lessen intra-articular haemorrhage and thereby provide adequate visualisation to the surgeon. Achievement of optimal conditions necessitates several interventions and manipulations by the anaesthesiologist and the surgeon, most of which directly or indirectly involve maintaining intra-operative blood pressure (BP) control.
This study aimed to compare the efficacy and convenience of target controlled infusion (TCI) of propofol and inhalational agent sevoflurane in patients undergoing shoulder arthroscopic surgery after preliminary inter-scalene blockade.
Of thirty four patients studied, seventeen received TCI propofol (target plasma concentration of 3 μg/ml) and an equal number, sevoflurane (1.2-1.5 Minimum Alveolar Concentration). N2O was used in both groups. Systolic, diastolic, mean blood pressures and heart rate were recorded regularly throughout the procedure. All interventions to control BP by the anaesthesiologist and pump manipulation requested by the surgeon were recorded. The volume of saline irrigant used and the haemoglobin (Hb) content of the return fluid were measured.
TCI propofol could achieve lower systolic, mean BP levels and the number of interventions required was also lower as compared to the sevoflurane group. The number of patients with measurable Hb was lower in the TCI propofol group and this translated into better visualisation of the joint space. A higher volume of saline irrigant was required in the sevoflurane group. No immediate peri-operative anaesthetic complications were noted in either category.
TCI propofol appears to be superior to and more convenient than sevoflurane anaesthesia in inter-scalene blocked patients undergoing shoulder arthroscopy.
肩关节镜手术麻醉的挑战之一是需要控制性低血压以减少关节内出血，从而为外科医生提供清晰的视野。要达到最佳条件，麻醉医生和外科医生需要进行多种干预和操作，其中大多数直接或间接涉及术中血压（BP）的控制。
本研究旨在比较异丙酚靶控输注（TCI）与吸入麻醉药七氟醚在臂丛神经阻滞下行肩关节镜手术患者中的有效性和便利性。
在34例研究患者中，17例接受异丙酚TCI（靶血浆浓度为3μg/ml），另外17例接受七氟醚（1.2 - 1.5最低肺泡浓度）。两组均使用氧化亚氮。在整个手术过程中定期记录收缩压、舒张压、平均血压和心率。记录麻醉医生控制血压的所有干预措施以及外科医生要求的泵操作。测量使用的生理盐水灌洗液量和回收液中的血红蛋白（Hb）含量。
与七氟醚组相比，异丙酚TCI能达到更低的收缩压和平均血压水平，所需的干预次数也更少。异丙酚TCI组中可测量Hb的患者数量更少，这意味着关节间隙的视野更好。七氟醚组需要更高量的生理盐水灌洗液。两组均未观察到围手术期即刻麻醉并发症。
在臂丛神经阻滞下行肩关节镜手术的患者中，异丙酚TCI似乎比七氟醚麻醉更优越且更方便。
