七氟醚是丙泊酚全凭静脉麻醉的有效辅助药物，可减轻非插管电视辅助胸腔镜手术中的咳嗽反射。

Sevoflurane is an effective adjuvant to propofol-based total intravenous anesthesia for attenuating cough reflex in nonintubated video-assisted thoracoscopic surgery.

作者信息

Lai Hou-Chuan, Huang Tsai-Wang, Tseng Wei-Cheng, Lin Wei-Lin, Chang Hung, Wu Zhi-Fu

机构信息

Department of Anesthesiology.

Division of Chest Surgery, Department of Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China.

出版信息

Medicine (Baltimore). 2018 Oct;97(42):e12927. doi: 10.1097/MD.0000000000012927.

DOI:10.1097/MD.0000000000012927

PMID:30335029

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6211903/

Abstract

BACKGROUND

Nonintubated video-assisted thoracic surgery (VATS) has been widely developed during the recent years. Cough reflex is an inevitably encountered problem while approaching lung lesions, and it may induce major bleeding. Sevoflurane anesthesia may attenuate cough reflex by inhibiting the pulmonary irritant receptors. However, the incidence of postoperative nausea and vomiting (PONV) in inhalational anesthesia is higher than in the propofol-based total intravenous anesthesia (TIVA). We investigated the effect of sevoflurane combination with propofol-based TIVA on cough reflex and PONV in nonintubated VATS.

METHODS

Ninety patients undergoing nonintubated VATS with laryngeal mask airway (LMA) and spontaneous breathing were randomly assigned for TIVA or propofol/sevoflurane anesthesia. In the TIVA group (n = 45), anesthesia was induced and maintained with propofol and fentanyl; in the propofol/sevoflurane (P/S) group (n = 45), 1% sevoflurane anesthesia was added to propofol and fentanyl anesthesia. The primary outcome measurements were cough reflex. In addition, the incidence of PONV and extubation time were investigated.

RESULTS

Patients with cough reflex were significantly fewer in the P/S group than in the TIVA group (10/45 vs 34/45; P < .001). The cough severity (35/5/5/0 vs 11/17/17/0; P < .001) and limb movement (40/5/0/0 vs 28/17/0/0; P < .001) were lower in the P/S group than in the TIVA group. Besides, incremental fentanyl bolus for cough reflex was 5 (0 [0-1]) in the P/S group and 17 (0 [0-3]) in the TIVA group (P < .05). And there was no conversion to general anesthesia, postoperative hemorrhage, aspiration pneumonia, or PONV in the 2 groups. Besides, there was no significant difference in extubation time (TIVA: 5.04 ± 2.88 vs P/S: 4.44 ± 2.98 minutes; P = .33).

CONCLUSION

Sevoflurane attenuated cough reflex under propofol-based TIVA and did not increase the incidence of PONV and extubation time in nonintubated VATS.

摘要

背景

近年来，非插管电视辅助胸腔镜手术（VATS）得到了广泛发展。在接近肺部病变时，咳嗽反射是一个不可避免会遇到的问题，并且可能导致大出血。七氟烷麻醉可能通过抑制肺刺激性感受器来减弱咳嗽反射。然而，吸入麻醉术后恶心呕吐（PONV）的发生率高于丙泊酚全静脉麻醉（TIVA）。我们研究了七氟烷联合丙泊酚TIVA对非插管VATS中咳嗽反射和PONV的影响。

方法

90例接受非插管VATS且使用喉罩气道（LMA）并自主呼吸的患者被随机分配接受TIVA或丙泊酚/七氟烷麻醉。在TIVA组（n = 45）中，麻醉诱导和维持使用丙泊酚和芬太尼；在丙泊酚/七氟烷（P/S）组（n = 45）中，在丙泊酚和芬太尼麻醉基础上加用1%七氟烷麻醉。主要观察指标为咳嗽反射。此外，还研究了PONV的发生率和拔管时间。

结果

P/S组咳嗽反射患者明显少于TIVA组（10/45 vs 34/45；P <.001）。P/S组的咳嗽严重程度（35/5/5/0 vs 11/17/17/0；P <.001）和肢体运动（40/5/0/0 vs 28/17/0/0；P <.001）低于TIVA组。此外，P/S组用于咳嗽反射的追加芬太尼推注量为5（0 [0 - 1]），TIVA组为17（0 [0 - 3]）（P <.05）。并且两组均未转为全身麻醉、术后出血、误吸性肺炎或PONV。此外，拔管时间无显著差异（TIVA：5.04 ± 2.88 vs P/S：4.44 ± 2.98分钟；P =.33）。