Kim Hyun-Chang, Hong Won-Pyo, Lim Young-Jin, Park Hee-Pyoung
Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Can J Anaesth. 2016 May;63(5):596-602. doi: 10.1007/s12630-016-0600-7. Epub 2016 Feb 1.
Catheter-related bladder discomfort (CRBD) due to an indwelling urinary catheter can cause postoperative distress, and the mechanism underlying CRBD is linked to the activation of muscarinic receptors. Inhalation of anesthetic agents, such as sevoflurane and desflurane, has differential inhibitory effects on muscarinic receptors. We aimed to compare the effect of intraoperative sevoflurane vs desflurane inhalation on postoperative CRBD.
Eighty-nine patients undergoing transurethral resection of a bladder tumour (TURBT) were randomly allocated to two groups. The sevoflurane group (n = 45) and the desflurane group (n = 44) received the respective inhalational agents for maintenance of general anesthesia. The incidence and severity (mild/moderate/severe) of CRBD were assessed at zero, one, six, and 24 hr postoperatively.
Catheter-related bladder discomfort during the first 24 hr postoperatively occurred in 34/45 (76%) patients receiving sevoflurane compared with 41/44 (93%) patients receiving desflurane [absolute difference 18%; 95% confidence interval [CI], 2 to 33; P = 0.039]. The differences in the rate of CRBD between the sevoflurane and desflurane groups at zero, one, and six hours postoperatively were 24% (95% CI, 7 to 40; P = 0.012), 33% (95% CI, 15 to 49; P = 0.001), and 26% (95% CI, 6 to 43; P = 0.019), respectively. The incidence of moderate to severe CRBD and the number of patients treated with tramadol for CRBD were comparable between the two groups.
As a maintenance agent of general anesthesia, sevoflurane reduced the incidence of early postoperative CRBD in patients undergoing TURBT when compared with desflurane. The protocol for this clinical trial was registered at ClinicalTrials.gov (NCT02096224).
留置导尿管引起的导管相关性膀胱不适（CRBD）可导致术后不适，CRBD的潜在机制与毒蕈碱受体的激活有关。吸入麻醉剂，如七氟醚和地氟醚，对毒蕈碱受体有不同的抑制作用。我们旨在比较术中吸入七氟醚与地氟醚对术后CRBD的影响。
89例行膀胱肿瘤经尿道切除术（TURBT）的患者被随机分为两组。七氟醚组（n = 45）和地氟醚组（n = 44）分别接受相应的吸入麻醉剂以维持全身麻醉。术后0、1、6和24小时评估CRBD的发生率和严重程度（轻度/中度/重度）。
术后24小时内，接受七氟醚的45例患者中有34例（76%）发生导管相关性膀胱不适，而接受地氟醚的44例患者中有41例（93%）发生[绝对差异18%；95%置信区间（CI），2%至33%；P = 0.039]。七氟醚组和地氟醚组术后0、1和6小时CRBD发生率的差异分别为24%（95%CI，7%至40%；P = 0.012）、33%（95%CI，15%至49%；P = 0.001）和26%（95%CI，6%至43%；P = 0.019）。两组中度至重度CRBD的发生率以及因CRBD接受曲马多治疗的患者数量相当。
作为全身麻醉的维持药物，与地氟醚相比，七氟醚降低了行TURBT患者术后早期CRBD的发生率。该临床试验方案已在ClinicalTrials.gov（NCT02096224）注册。
