全身麻醉与清醒区域麻醉后婴儿血压的差异（GAS研究 - 一项前瞻性随机试验）
Differences in Blood Pressure in Infants After General Anesthesia Compared to Awake Regional Anesthesia (GAS Study-A Prospective Randomized Trial).
作者信息
McCann M E, Withington D E, Arnup S J, Davidson A J, Disma N, Frawley G, Morton N S, Bell G, Hunt R W, Bellinger D C, Polaner D M, Leo A, Absalom A R, von Ungern-Sternberg B S, Izzo F, Szmuk P, Young V, Soriano S G, de Graaff J C
机构信息
From the *Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; †Department of Anesthesia, Montreal Children's Hospital, Montreal, Canada; ‡Department of Anesthesia, McGill University, Montreal, Canada; §Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; ‖Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; ¶Department of Anaesthesia and Pain Management, the Royal Children's Hospital, Melbourne, Victoria, Australia; #Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; **Department of Anaesthesia, Istituto Giannina Gaslini, Genoa, Italy; ††Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow, United Kingdom; ‡‡Department of Anaesthesia, Royal Hospital for Sick Children, Glasgow, United Kingdom; §§Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia; ‖‖Neonatal Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; ¶¶Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; ##Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; ***Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; †††Departments of Anesthesiology and Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado; ‡‡‡Department of Anaesthesia, Royal Children's Hospital, Melbourne, Australia; §§§University Medical Center Groningen, Groningen University, the Netherlands; ‖‖‖Pharmacology, Pharmacy, Anaesthesiology Unit, School of Medicine and Pharmacology, the University of Western Australia, Perth, Western Australia, Australia; ¶¶¶Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Western Australia, Australia; ###Department of Anaesthesiology and Intensive Care, Paediatric Intensive Care Unit Children Hospital 'Vittore Buzzi', Milano, Italy; ****Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children's Health Medical Center, Dallas, Texas; ††††Outcome Research Consortium, Cleveland, Ohio; ‡‡‡‡Department of Anaesthesiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; §§§§Brain Center Rudolph Magnus, University Medical Centre Utrecht, the Netherlands; and ‖‖‖‖Department of Anesthesia, Sophia Children's Hospital, Erasmus Medical Center Rotterdam, the Netherlands.
出版信息
Anesth Analg. 2017 Sep;125(3):837-845. doi: 10.1213/ANE.0000000000001870.
BACKGROUND
The General Anesthesia compared to Spinal anesthesia (GAS) study is a prospective randomized, controlled, multisite, trial designed to assess the influence of general anesthesia (GA) on neurodevelopment at 5 years of age. A secondary aim obtained from the blood pressure data of the GAS trial is to compare rates of intraoperative hypotension after anesthesia and to identify risk factors for intraoperative hypotension.
METHODS
A total of 722 infants ≤60 weeks postmenstrual age undergoing inguinal herniorrhaphy were randomized to either bupivacaine regional anesthesia (RA) or sevoflurane GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born at <26 weeks of gestation. Moderate hypotension was defined as mean arterial pressure measurement of <35 mm Hg. Any hypotension was defined as mean arterial pressure of <45 mm Hg. Epochs were defined as 5-minute measurement periods. The primary outcome was any measured hypotension <35 mm Hg from start of anesthesia to leaving the operating room. This analysis is reported primarily as intention to treat (ITT) and secondarily as per protocol.
RESULTS
The relative risk of GA compared with RA predicting any measured hypotension of <35 mm Hg from the start of anesthesia to leaving the operating room was 2.8 (confidence interval [CI], 2.0-4.1; P < .001) by ITT analysis and 4.5 (CI, 2.7-7.4, P < .001) as per protocol analysis. In the GA group, 87% and 49%, and in the RA group, 41% and 16%, exhibited any or moderate hypotension by ITT, respectively. In multivariable modeling, group assignment (GA versus RA), weight at the time of surgery, and minimal intraoperative temperature were risk factors for hypotension. Interventions for hypotension occurred more commonly in the GA group compared with the RA group (relative risk, 2.8, 95% CI, 1.7-4.4 by ITT).
CONCLUSIONS
RA reduces the incidence of hypotension and the chance of intervention to treat it compared with sevoflurane anesthesia in young infants undergoing inguinal hernia repair.
背景
全身麻醉与脊髓麻醉比较（GAS）研究是一项前瞻性随机对照多中心试验，旨在评估全身麻醉（GA）对5岁时神经发育的影响。从GAS试验的血压数据得出的次要目标是比较麻醉后术中低血压的发生率，并确定术中低血压的危险因素。
方法
共有722名月经后年龄≤60周接受腹股沟疝修补术的婴儿被随机分为布比卡因区域麻醉（RA）或七氟醚全身麻醉组。排除标准包括不良神经发育结局的危险因素以及妊娠<26周出生的婴儿。中度低血压定义为平均动脉压测量值<35 mmHg。任何低血压定义为平均动脉压<45 mmHg。时间段定义为5分钟测量期。主要结局是从麻醉开始到离开手术室期间任何测量到的低血压<35 mmHg。本分析主要按意向性分析（ITT）报告，其次按方案分析报告。
结果
通过ITT分析，与RA相比，GA预测从麻醉开始到离开手术室期间任何测量到的低血压<35 mmHg的相对风险为2.8（置信区间[CI]，2.0 - 4.1；P <.001），按方案分析为4.5（CI，2.7 - 7.4，P <.001）。在ITT分析中，GA组分别有87%和49%，RA组分别有41%和16%出现任何或中度低血压。在多变量模型中，分组（GA与RA）、手术时体重和术中最低温度是低血压的危险因素。与RA组相比，GA组低血压干预更常见（ITT分析相对风险为2.8，95%CI，1.7 - 4.4）。
结论
在接受腹股沟疝修补术的幼儿中，与七氟醚麻醉相比，RA降低了低血压的发生率和治疗低血压的干预机会。
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