正颌外科手术中全静脉麻醉的研究

A study on total intravenous anesthesia in orthognathic surgical procedures.

作者信息

Vasundhar P L, Sadhasivam Gokkulakrishnan, Bhushan Satya, Kalyan Siva, Chiang Kho Chai

机构信息

Department of OMFS, Drs Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Vijayawada, India.

Department of OMFS, Adhiparasakthi Dental College and Hospital, Melmaruvathur, Dr. MGR Medical University, Guindy, Chennai, Tamil Nadu, India.

出版信息

Natl J Maxillofac Surg. 2016 Jul-Dec;7(2):127-135. doi: 10.4103/0975-5950.201351.

DOI:10.4103/0975-5950.201351

PMID:28356683

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5357933/

Abstract

AIMS AND OBJECTIVE

To assess the use of propofol for induction and maintenance of anaesthesia among patients undergoing various combinations of orthognathic surgical procedures.

MATERIALS AND METHODS

Following Preoperative evaluation, patients were given Fentanyl (2 micrograms/kg) intravenously. Induction (2 mg/kg) and maintenance (10 mg/kg/hr) of anaesthesia was achieved by Propofol infusion. Blood Pressure and heart rate were maintained at >70 or 80 mm Hg and >50 respectively and were monitored continuously. Infusion was stopped approximately 30 to 40 minutes before the end of surgery. Immediate recovery recorded and was assessed.

RESULTS

The average duration of anaesthesia and surgery were found to be 4 hrs 28 min (SD= 1 hr. 35 min) and 4 hrs 3 min (SD=1 hr 38 min). None of the patients experienced pain on injection of induction agent. No significant change was observed in the mean heart rate and mean BP at different time intervals from baseline value to 30 minutes after the recovery. The average time taken to obey simple commands after stopping Propofol infusion was 42.60 ± 9.09 min. Time taken for spontaneous eye opening, full orientation and to count backwards was 43.45 ± 9.11, 47.85 ± 8.18 and 50.9 ± 9.14 respectively. Face-Hand test performed at 15 min after extubation was positive in all the patients. The mean Aldrete score at 15 min after extubation was 11.65 ± 0.75. The mean value of unaided sitting time for at least 2 min was after 119.00 ± 20.56 min. The average score of picture card test, time taken in "picking up matches" test, Ball bearing test, time taken to walk and to void urine were 5.80 ± 1.47, 67.95 ± 5.72, 9.80 ± 2.57, 172.75 ± 39.25 and 163.75 ± 55.96 respectively. Ninety percent of the patients were amenable for a repeat of this anaesthetic using the same regime but 10% of them did not answer anything. Seven patients (35%) had chills post-operatively.

CONCLUSION

Propofol is an excellent anaesthetic for day care procedures.

摘要

目的

评估丙泊酚在接受各种正颌外科手术组合的患者中用于麻醉诱导和维持的情况。

材料与方法

术前评估后，患者静脉注射芬太尼（2微克/千克）。通过丙泊酚输注实现麻醉诱导（2毫克/千克）和维持（10毫克/千克/小时）。血压和心率分别维持在>70或80毫米汞柱和>50，并持续监测。在手术结束前约30至40分钟停止输注。记录并评估即刻恢复情况。

结果

麻醉和手术的平均持续时间分别为4小时28分钟（标准差=1小时35分钟）和4小时3分钟（标准差=1小时38分钟）。没有患者在注射诱导剂时感到疼痛。从基线值到恢复后30分钟的不同时间间隔内，平均心率和平均血压均未观察到显著变化。停止丙泊酚输注后服从简单指令的平均时间为42.60±9.09分钟。自主睁眼、完全定向和倒数的时间分别为43.45±9.11、47.85±8.18和50.9±9.14分钟。拔管后15分钟进行的面手试验在所有患者中均为阳性。拔管后15分钟的平均Aldrete评分为11.65±0.75。至少坐2分钟的自主坐立时间平均值为119.00±20.56分钟。图片卡片测试的平均得分、“捡起火柴”测试的时间、滚珠轴承测试、行走和排尿的时间分别为5.80±1.47、67.95±5.72、9.80±2.57、172.75±39.25和163.75±55.96。90%的患者愿意使用相同方案重复这种麻醉，但其中10%没有回应。7名患者（35%）术后出现寒战。