Shafer A, White P F, Urquhart M L, Doze V A
Department of Anesthesia, Stanford University School of Medicine, California.
Anesthesiology. 1989 Oct;71(4):495-501.
The perioperative effects of administering sedative and analgesic drugs prior to outpatient surgery were evaluated. One hundred fifty adult outpatients were randomly assigned to one of six study groups according to a double-blind protocol design. Patients were given placebo (saline) or midazolam (5 mg im) 30-60 min prior to surgery, and then either placebo, oxymorphone (1 mg iv), or fentanyl (100 micrograms iv) 3-5 min prior to a standardized anesthetic technique. Preoperatively, midazolam premedication was associated with a significantly lower anxiety level (37 +/- 29 mm vs. 50 +/- 32 mm, P less than 0.05), higher sedation level (254 +/- 136 mm vs. 145 +/- 109 mm, P less than 0.01), worsening of psychomotor skill (5 +/- 5 vs. 2 +/- 2 dots missed, P less than 0.01; midazolam vs. placebo), and impaired recall abilities. In addition, use of midazolam did not prolong the discharge time. Compared to control patients, those who received fentanyl had a decreased incidence of intraoperative airway difficulties such as coughing (28% vs. 0%, P less than 0.01). Although use of opioids increased the incidence of postoperative nausea (42% vs. 18%, P less than 0.01) and vomiting (23% vs. 2%, P less than 0.01; opioid vs. no opioid), average recovery times were not affected by opioid administration. Oxymorphone use was associated with a lower incidence of pain at home compared with that following fentanyl (46% vs. 74%, P less than 0.05). Finally, preoperative administration of both midazolam and fentanyl or oxymorphone prior to a standardized methohexital-nitrous oxide anesthetic technique did not adversely affect recovery after outpatient surgery.
评估了门诊手术前使用镇静和镇痛药物的围手术期效果。150名成年门诊患者根据双盲方案设计被随机分配到六个研究组之一。患者在手术前30 - 60分钟给予安慰剂（生理盐水）或咪达唑仑（5毫克肌肉注射），然后在标准化麻醉技术前3 - 5分钟给予安慰剂、羟吗啡酮（1毫克静脉注射）或芬太尼（100微克静脉注射）。术前，咪达唑仑预处理与显著较低的焦虑水平（37±29毫米对50±32毫米，P<0.05）、较高的镇静水平（254±136毫米对145±109毫米，P<0.01）、心理运动技能恶化（漏点5±5对2±2，P<0.01；咪达唑仑对安慰剂）以及记忆能力受损有关。此外，使用咪达唑仑并未延长出院时间。与对照组患者相比，接受芬太尼的患者术中气道困难如咳嗽的发生率降低（28%对0%，P<0.01）。虽然使用阿片类药物增加了术后恶心（42%对18%，P<0.01）和呕吐（23%对2%，P<0.01；阿片类药物对无阿片类药物）的发生率，但平均恢复时间不受阿片类药物给药的影响。与芬太尼相比，使用羟吗啡酮后在家中疼痛的发生率较低（46%对74%，P<0.05）。最后，在标准化的甲己炔巴比妥 - 氧化亚氮麻醉技术前，术前给予咪达唑仑和芬太尼或羟吗啡酮对门诊手术后的恢复没有不利影响。
