吸入与静脉诱导麻醉在围手术期呼吸不良事件高危患儿中的应用：一项随机对照试验。
Inhalational versus Intravenous Induction of Anesthesia in Children with a High Risk of Perioperative Respiratory Adverse Events: A Randomized Controlled Trial.
机构信息
From the Department of Anesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Australia (A.R., M.H., B.S.v.U.-S.) the Children's Lung Health, Telethon Kids Institute, Subiaco, Australia (A.R., G.L.H., B.S.v.U.-S.) the School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia (G.L.H.) the Centre for Child Health Research, University of Western Australia, Perth, Australia (G.L.H.) Anesthesiology Unit, Medical School, The University of Western Australia, Perth, Australia (B.S.v.U.-S.) the School of Public Health, Curtin University, Perth, Australia (G.Z.) the Centre for Genetic Origins of Health and Disease, Curtin University and University of Western Australia, Perth, Australia (G.Z.).
出版信息
Anesthesiology. 2018 Jun;128(6):1065-1074. doi: 10.1097/ALN.0000000000002152.
BACKGROUND
Limited evidence suggests that children have a lower incidence of perioperative respiratory adverse events when intravenous propofol is used compared with inhalational sevoflurane for the anesthesia induction. Limiting these events can improve recovery time as well as decreasing surgery waitlists and healthcare costs. This single center open-label randomized controlled trial assessed the impact of the anesthesia induction technique on the occurrence of perioperative respiratory adverse events in children at high risk of those events.
METHODS
Children (N = 300; 0 to 8 yr) with at least two clinically relevant risk factors for perioperative respiratory adverse events and deemed suitable for either technique of anesthesia induction were recruited and randomized to either intravenous propofol or inhalational sevoflurane. The primary outcome was the difference in the rate of occurrence of perioperative respiratory adverse events between children receiving intravenous induction and those receiving inhalation induction of anesthesia.
RESULTS
Children receiving intravenous propofol were significantly less likely to experience perioperative respiratory adverse events compared with those who received inhalational sevoflurane after adjusting for age, sex, American Society of Anesthesiologists physical status and weight (perioperative respiratory adverse event: 39/149 [26%] vs. 64/149 [43%], relative risk [RR]: 1.7, 95% CI: 1.2 to 2.3, P = 0.002, respiratory adverse events at induction: 16/149 [11%] vs. 47/149 [32%], RR: 3.06, 95% CI: 1.8 to 5. 2, P < 0.001).
CONCLUSIONS
Where clinically appropriate, anesthesiologists should consider using an intravenous propofol induction technique in children who are at high risk of experiencing perioperative respiratory adverse events.
VISUAL ABSTRACT
An online visual overview is available for this article at http://links.lww.com/ALN/B725.
背景
有限的证据表明，与吸入七氟醚相比，儿童在接受静脉注射异丙酚诱导麻醉时，围手术期呼吸不良事件的发生率较低。限制这些事件可以缩短恢复时间，减少手术候补名单和医疗保健成本。这项单中心开放标签随机对照试验评估了麻醉诱导技术对高风险围手术期呼吸不良事件儿童的影响。
方法
招募了至少有两种与围手术期呼吸不良事件相关的临床相关危险因素且适合两种麻醉诱导技术的儿童（300 例；0 至 8 岁），并将其随机分为静脉注射异丙酚或吸入七氟醚组。主要结局是接受静脉诱导的儿童与接受吸入诱导的儿童之间围手术期呼吸不良事件的发生率差异。
结果
调整年龄、性别、美国麻醉医师协会身体状况和体重后，与接受吸入七氟醚的儿童相比，接受静脉注射异丙酚的儿童发生围手术期呼吸不良事件的可能性显著降低（围手术期呼吸不良事件：39/149[26%]与 64/149[43%]，相对风险[RR]：1.7，95%CI：1.2 至 2.3，P=0.002；诱导时呼吸不良事件：16/149[11%]与 47/149[32%]，RR：3.06，95%CI：1.8 至 5.2，P<0.001）。
结论
在临床合适的情况下，麻醉师应考虑在高风险发生围手术期呼吸不良事件的儿童中使用静脉注射异丙酚诱导技术。
直观概述
本文有在线直观概述，可在 http://links.lww.com/ALN/B725 查看。
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