Lu Chueng-He, Wu Zhi-Fu, Lin Bo-Feng, Lee Meei-Shyuan, Lin Chin, Huang Yuan-Shiou, Huang Yi-Hsuan
Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center; and.
School of Public Health and.
J Neurosurg Spine. 2016 Feb;24(2):268-274. doi: 10.3171/2015.4.SPINE141143. Epub 2015 Oct 13.
OBJECT Anesthesia techniques can contribute to the reduction of anesthesia-controlled time and may therefore improve operating room efficiency. However, little is known about the difference in anesthesia-controlled time between propofol-based total intravenous anesthesia (TIVA) and desflurane (DES) anesthesia techniques for prolonged lumbar spine surgery under general anesthesia. METHODS A retrospective analysis was conducted using hospital databases to compare the anesthesia-controlled time of lengthy (surgical time > 180 minutes) lumbar spine surgery in patients receiving either TIVA via target-controlled infusion (TCI) with propofol/fentanyl or DES/fentanyl-based anesthesia, between January 2009 and December 2011. A variety of time intervals (surgical time, anesthesia time, extubation time, time in the operating room, postanesthesia care unit [PACU] length of stay, and total surgical suite time) comprising perioperative hemodynamic variables were compared between the 2 anesthesia techniques. RESULTS Data from 581 patients were included in the analysis; 307 patients received TIVA and 274 received DES anesthesia. The extubation time was faster (12.4 ± 5.3 vs 7.0 ± 4.5 minutes, p < 0.001), and the time in operating room and total surgical suite time was shorter in the TIVA group than in the DES group (326.5 ± 57.2 vs 338.4 ± 69.4 minutes, p = 0.025; and 402.6 ± 60.2 vs 414.4 ± 71.7 minutes, p = 0.033, respectively). However, there was no statistically significant difference in PACU length of stay between the groups. Heart rate and mean arterial blood pressure were more stable during extubation in the TIVA group than in the DES group. CONCLUSIONS Utilization of TIVA reduced the mean time to extubation and total surgical suite time by 5.4 minutes and 11.8 minutes, respectively, and produced more stable hemodynamics during extubation compared with the use of DES anesthesia in lengthy lumbar spine surgery.
目的 麻醉技术有助于缩短麻醉控制时间，从而提高手术室效率。然而，对于全身麻醉下长时间腰椎手术，基于丙泊酚的全静脉麻醉（TIVA）与地氟烷（DES）麻醉技术在麻醉控制时间上的差异知之甚少。方法 利用医院数据库进行回顾性分析，比较2009年1月至2011年12月期间接受丙泊酚/芬太尼靶控输注（TCI）的TIVA或基于地氟烷/芬太尼麻醉的长时间（手术时间>180分钟）腰椎手术患者的麻醉控制时间。比较两种麻醉技术之间包括围手术期血流动力学变量的各种时间间隔（手术时间、麻醉时间、拔管时间、在手术室的时间、麻醉后护理单元[PACU]停留时间和手术套房总时间）。结果 581例患者的数据纳入分析；307例患者接受TIVA，274例接受DES麻醉。TIVA组拔管时间更快（12.4±5.3 vs 7.0±4.5分钟，p<0.001），且在手术室的时间和手术套房总时间比DES组短（分别为326.5±57.2 vs 338.4±69.4分钟，p = 0.025；402.6±60.2 vs 414.4±71.7分钟，p = 0.033）。然而，两组之间PACU停留时间无统计学显著差异。TIVA组拔管期间心率和平均动脉血压比DES组更稳定。结论 在长时间腰椎手术中，与使用DES麻醉相比，TIVA的使用分别使平均拔管时间和手术套房总时间缩短了5.4分钟和11.8分钟，并且在拔管期间产生了更稳定的血流动力学。
