Ministry of Health, Yıldırım Beyazıt Training Hospital, Ankara, Turkey.
TDV 29 Mayıs Hospital, Ankara, Turkey.
J Clin Anesth. 2017 Feb;37:25-30. doi: 10.1016/j.jclinane.2016.10.036. Epub 2016 Dec 22.
The use of short-acting anesthetics has introduced a "fast-track anesthesia" concept in outpatient surgery which provides discharge of the patients from operation room directly to the phase II recovery area without entering into postanesthesia care unit. The aim of this prospective and randomized study was to compare general anesthesia using sevoflurane with propofol-remifentanil-based total intravenous anesthesia (TIVA) for fast-track eligibility in patients undergoing outpatient laparoscopic cholecystectomy. The secondary aim was to compare 2 discharge scoring systems: White's Fast-Tracking Scoring System (WFTSS) and Modified Aldrete Scoring Systems (MASS) with regard to postanesthesia care unit bypass rate and postoperative problems.
After obtaining ethical approval and written informed patient consent, 80 patients were randomly assigned into 2 groups: group sevoflurane (n=40) and group TIVA (n=40). Anesthesia was induced with propofol, fentanyl, and rocuronium in both groups and maintained with sevoflurane in group sevoflurane and with remifentanil-propofol in group TIVA. Fast-track eligibility was evaluated using both WFTSS and MASS while patients were discharged from operation room according to WFTSS. Recovery times, number of fast-track eligible patients, factors related to fast-track ineligibility, and perioperative complications were evaluated.
The ratio of fast-track eligible patients was higher and times to fast-track eligibility were shorter in group TIVA compared with group sevoflurane (82.1% vs 57.5% and 8 minutes vs 12 minutes; P<.05). The primary factors that have inhibited fast-tracking were desaturation, hemodynamic instability, pain, and postoperative nausea and vomiting, respectively. Postoperative nausea and vomiting presented a major difference in the rate of fast-track ineligibility between groups (4 patients in group sevoflurane, whereas none in group TIVA; P<.05). The fast-track ratio was lower with the WFTSS compared with MASS in group sevoflurane (57.5% vs 77.5%, P<.05), but similar in group TIVA.
在门诊手术中使用短效麻醉剂引入了“快速通道麻醉”的概念，它可以使患者从手术室直接进入第二阶段恢复区，而无需进入麻醉后护理单元。本前瞻性、随机研究的目的是比较使用七氟醚的全身麻醉与依托咪酯-瑞芬太尼全凭静脉麻醉（TIVA）在接受门诊腹腔镜胆囊切除术患者中进行快速通道的资格。次要目的是比较两种出院评分系统：White 的快速通道评分系统（WFTSS）和改良 Aldrete 评分系统（MASS）在术后护理单元旁路率和术后问题方面的差异。
在获得伦理批准和书面知情患者同意后，将 80 名患者随机分为 2 组：七氟醚组（n=40）和 TIVA 组（n=40）。两组均采用异丙酚、芬太尼和罗库溴铵诱导麻醉，七氟醚组维持七氟醚麻醉，TIVA 组维持瑞芬太尼-异丙酚麻醉。根据 WFTSS，从手术室出院时，使用 WFTSS 和 MASS 评估快速通道资格。评估恢复时间、快速通道合格患者的数量、快速通道不合格的相关因素以及围手术期并发症。
与七氟醚组相比，TIVA 组的快速通道合格患者比例更高，达到快速通道合格的时间更短（82.1%比 57.5%和 8 分钟比 12 分钟；P<.05）。抑制快速通道的主要因素分别是血氧饱和度下降、血流动力学不稳定、疼痛和术后恶心呕吐。术后恶心呕吐在两组之间的快速通道不合格率方面存在显著差异（七氟醚组 4 例，而 TIVA 组无 1 例；P<.05）。在七氟醚组中，WFTSS 的快速通道比例低于 MASS（57.5%比 77.5%，P<.05），但在 TIVA 组中相似。
