1Department Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada. 2Department Anesthesia and Pain Management, Christian Medical College, Vellore, India. 3Divison of Cardiac Surgery, Toronto General Hospital, Toronto, ON, Canada.
Crit Care Med. 2015 May;43(5):1062-9. doi: 10.1097/CCM.0000000000000938.
To evaluate the differences in extubation times in a group of cardiac surgical patients who were anesthetized and sedated with either IV propofol or inhaled volatile anesthetic agents.
This was a prospective randomized controlled trial performed between September 2009 and August 2011.
Cardiovascular ICU within a tertiary referral university-affiliated teaching hospital.
One hundred forty-one patients undergoing coronary artery bypass graft surgery with normal or mildly reduced left ventricular systolic function.
Participants were randomly assigned to receive anesthesia and postoperative sedation using IV propofol (n = 74) or inhaled volatile (isoflurane or sevoflurane) anesthetic agent (n = 67).
Patients sedated using inhaled volatile agent displayed faster readiness to extubation time at 135 minutes (95-200 min) compared with those receiving IV propofol at 215 minutes (150-280 min) (p < 0.001). Extubation times were faster within the volatile group at 182 minutes (140-255 min) in comparison with propofol group at 291 minutes (210-420 min) (p < 0.001). The volatile group showed a higher prevalence of vasodilatation with hypotension and higher cardiac outputs necessitating greater use of vasoconstrictors. There was no difference in postoperative pain scores, opioid consumption, sedation score, ICU or hospital length of stay, or patient mortality.
Inhaled volatile anesthesia and sedation facilitates faster extubation times in comparison with IV propofol for patient undergoing coronary artery bypass graft surgery.
评估接受静脉注射异丙酚或吸入挥发性麻醉剂麻醉和镇静的心脏手术患者的拔管时间差异。
这是一项在 2009 年 9 月至 2011 年 8 月间进行的前瞻性随机对照试验。
三级转诊大学附属医院的心血管 ICU。
141 例行冠状动脉旁路移植术且左心室收缩功能正常或轻度降低的患者。
参与者随机分为静脉注射异丙酚（n = 74）或吸入挥发性（异氟烷或七氟醚）麻醉剂（n = 67）组接受麻醉和术后镇静。
接受吸入挥发性麻醉剂镇静的患者准备拔管的时间更快，为 135 分钟（95-200 分钟），而接受静脉注射异丙酚的患者为 215 分钟（150-280 分钟）（p < 0.001）。与异丙酚组的 291 分钟（210-420 分钟）相比，挥发性组的拔管时间更快，为 182 分钟（140-255 分钟）（p < 0.001）。挥发性组显示出更高的血管扩张和低血压发生率，以及更高的心脏输出量，需要更多地使用血管收缩剂。术后疼痛评分、阿片类药物消耗、镇静评分、ICU 或住院时间或患者死亡率无差异。
与静脉注射异丙酚相比，接受冠状动脉旁路移植术的患者吸入挥发性麻醉和镇静可更快地拔管。
