Department of Anaesthesia and Intensive Care, University College London Hospitals NHS Foundation Trust, London, UK; Department of Peri-operative Medicine, University College London, London, UK.
Anaesthesia. 2014 Oct;69(10):1138-50. doi: 10.1111/anae.12713. Epub 2014 May 22.
With the popularity of ambulatory surgery ever increasing, we carried out a systematic review and meta-analysis to determine whether the type of anaesthesia used had any bearing on patient outcomes. Total intravenous propofol anaesthesia was compared with two of the newer inhalational agents, sevoflurane and desflurane. In total, 18 trials were identified; only trials where nitrous oxide was administered to, or omitted from, both groups were included. A total of 1621 patients were randomly assigned to either propofol (685 patients) or inhalational anaesthesia (936 patients). If surgical causes of unplanned admissions were excluded, there was no difference in unplanned admission to hospital between propofol and inhalational anaesthesia (1.0% vs 2.9%, respectively; p = 0.13). The incidence of postoperative nausea and vomiting was lower with propofol than with inhalational agents (13.8% vs 29.2%, respectively; p < 0.001). However, no difference was noted in post-discharge nausea and vomiting (23.9% vs 20.8%, respectively; p = 0.26). Length of hospital stay was shorter with propofol, but the difference was only 14 min on average. The use of propofol was also more expensive, with a mean (95% CI) difference of £6.72 (£5.13-£8.31 (€8.16 (€6.23-€10.09); $11.29 ($8.62-$13.96))) per patient-anaesthetic episode (p < 0.001). Therefore, based on the published evidence to date, maintenance of anaesthesia using propofol appeared to have no bearing on the incidence of unplanned admission to hospital and was more expensive, but was associated with a decreased incidence of early postoperative nausea and vomiting compared with sevoflurane or desflurane in patients undergoing ambulatory surgery.
随着日间手术的普及，我们进行了一项系统评价和荟萃分析，以确定所使用的麻醉类型是否对患者的结局有影响。全凭静脉注射异丙酚麻醉与两种新型吸入性麻醉剂（七氟醚和地氟醚）进行了比较。共确定了 18 项试验；仅包括将氧化亚氮给予或不给予两组的试验。共有 1621 名患者被随机分配至异丙酚组（685 名患者）或吸入性麻醉组（936 名患者）。如果排除因手术原因导致的非计划住院，异丙酚和吸入性麻醉之间的非计划住院率无差异（分别为 1.0%和 2.9%；p=0.13）。与吸入性麻醉剂相比，异丙酚的术后恶心和呕吐发生率较低（分别为 13.8%和 29.2%；p<0.001）。然而，出院后恶心和呕吐发生率无差异（分别为 23.9%和 20.8%；p=0.26）。异丙酚组的住院时间较短，但平均仅相差 14 分钟。异丙酚的使用也更昂贵，平均（95%CI）差异为 6.72 英镑（5.13-8.31 欧元）（8.16-10.09 美元）；11.29 美元（8.62-13.96 美元））/每位麻醉患者（p<0.001）。因此，根据目前已发表的证据，使用异丙酚维持麻醉似乎与非计划住院率无关，而且更昂贵，但与七氟醚或地氟醚相比，在接受日间手术的患者中，术后早期恶心和呕吐的发生率较低。
