丙泊酚联合舒芬太尼或阿芬太尼用于乳腺癌手术全凭静脉麻醉（TIVA）的两种临床方案比较

Comparison of Two Clinical Protocols for Total Intravenous Anesthesia (TIVA) for Breast Surgery Using Propofol Combined With Either Sufentanil or Alfentanil.

作者信息

Radke Oliver C, Sippel Darja, Radke Katja, Hilgers Reinhard, Saur Petra

机构信息

Department of Anesthesia and Perioperative Care, San Francisco General Hospital, University of California in San Francisco, San Francisco, USA ; Department of Anesthesia, University Hospital of Dresden, Dresden, Germany.

Department of Visceral Surgery and Medicine, University Hospital Bern, Inselspital, Switzerland.

出版信息

Anesth Pain Med. 2014 Sep 3;4(4):e19278. doi: 10.5812/aapm.19278. eCollection 2014 Oct.

DOI:10.5812/aapm.19278

PMID:25337474

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4199218/

Abstract

BACKGROUND

Sufentanil and alfentanil have pharmacokinetic and dynamic properties which make them favourable substances for total intravenous anesthesia (TIVA) in combination with propofol.

OBJECTIVES

We planned to compare two clinical protocols for TIVA with propofol, and either sufentanil or alfentanil in regards to postoperative pain, hemodynamic stability during the case and time for emergence from anesthesia.

PATINETS AND METHODS

Treaty eight patients scheduled for general anesthesia for breast surgery were included in this Double-blind, randomized, controlled trial. All patients received a standardized TIVA with propofol and either 0.2 µg kg(-1) sufentanil or 20 µg kg(-1) alfentanil for induction and 0.3 µg kg(-1) h(-1) sufentanil or 30 µg kg(-1) h(-1) alfentanil for maintenance with additional propofol boluses as needed. During anesthesia, heart rate, non-invasive blood-pressure, peripheral oxygen saturation and depth of anesthesia, were recorded. In the post anesthesia care unit, pain scores, nausea and vomiting as well as medications were recorded.

RESULTS

Patients in the sufentanil group required less often additional opioid and propofol boluses to maintain adequate anesthesia. We did not observe a significant difference in time to extubation. Postoperatively, patients in the sufentanil group had less pain (P = 0.03) and required less i.v. opioids (0.4 vs. 1.9 mg piritramid, P = 0.04).

CONCLUSIONS

Both protocols provide excellent anesthesia, but patients receiving sufentnail had more stable anesthesia and less postoperative pain.

摘要

背景

舒芬太尼和阿芬太尼具有药代动力学和药效学特性，使其成为与丙泊酚联合用于全静脉麻醉（TIVA）的理想药物。

目的

我们计划比较两种丙泊酚联合舒芬太尼或阿芬太尼用于TIVA的临床方案，比较术后疼痛、术中血流动力学稳定性以及麻醉苏醒时间。

患者与方法

本双盲、随机、对照试验纳入了8例计划行乳腺手术全身麻醉的患者。所有患者均接受标准化的丙泊酚TIVA，诱导时给予0.2μg/kg舒芬太尼或20μg/kg阿芬太尼，维持时给予0.3μg·kg⁻¹·h⁻¹舒芬太尼或30μg·kg⁻¹·h⁻¹阿芬太尼，并根据需要追加丙泊酚 bolus。麻醉期间记录心率、无创血压、外周血氧饱和度和麻醉深度。在麻醉后护理单元，记录疼痛评分、恶心呕吐情况以及用药情况。