Kim Hye Jin, Kim Min-Soo, Kim Ha Yan, Park Wyun Kon, Kim Won Shik, Kim Sungmi, Kim Hyun Joo
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea.
Laryngoscope. 2020 Dec;130(12):2900-2905. doi: 10.1002/lary.28533. Epub 2020 Jan 27.
OBJECTIVE/HYPOTHESIS: Fentanyl is commonly administered toward the end of tonsillectomy to prevent emergence delirium and reduce postoperative pain. However, it can delay emergence from anesthesia and increase the risk of postoperative nausea and vomiting (PONV). The goal of our study was to compare the risk of PONV based on the timing of fentanyl administration at the end of tonsillectomy in children.
Prospective, double-blind, randomized controlled trial.
One hundred forty patients aged 3 to 7 years undergoing tonsillectomy were divided into two groups. Fentanyl (1 μg/kg) was administered at the end of surgery in group 1 (n = 70) and at 10 to 15 minutes before the end of surgery in group 2 (n = 70). Time to regular breathing and time to emergence from anesthesia were measured from the end of surgery. PONV and pediatric anesthesia emergence delirium scale scores were assessed every 10 minutes after admission to the postanesthesia care unit.
Incidences of PONV (2.9% vs. 2.9%, P > .99) and emergence delirium (11.4% vs. 5.7%, P = .23) were not significantly different between the two groups. Time to regular breathing (mean difference = 2.3 minutes; 95% confidence interval [CI]: 0.9 to 3.7 minutes) and time to emergence (median difference = 6.5 minutes; 95% CI, 2.5 to 10.5 minutes) were significantly longer in group 1 than in group 2.
Although there was no beneficial effect on PONV, recovery of regular breathing and consciousness was quicker with earlier fentanyl administration. Emergence delirium was well-controlled, similar to that with fentanyl administration at the end of surgery.
1b Laryngoscope, 2020.
目的/假设：芬太尼通常在扁桃体切除手术接近尾声时给药，以预防苏醒期谵妄并减轻术后疼痛。然而，它可能会延迟麻醉苏醒，并增加术后恶心呕吐（PONV）的风险。我们研究的目的是比较儿童扁桃体切除手术结束时不同时间点给予芬太尼后PONV的风险。
前瞻性、双盲、随机对照试验。
140例年龄在3至7岁接受扁桃体切除手术的患者被分为两组。第1组（n = 70）在手术结束时给予芬太尼（1μg/kg），第2组（n = 70）在手术结束前10至15分钟给予芬太尼。从手术结束时开始测量恢复正常呼吸的时间和麻醉苏醒时间。进入麻醉后护理单元后，每10分钟评估一次PONV和小儿麻醉苏醒谵妄量表评分。
两组之间PONV的发生率（2.9%对2.9%，P > 0.99）和苏醒期谵妄的发生率（11.4%对5.7%，P = 0.23）没有显著差异。第1组恢复正常呼吸的时间（平均差异 = 2.3分钟；95%置信区间[CI]：0.9至3.7分钟）和苏醒时间（中位数差异 = 6.5分钟；95%CI，2.5至10.5分钟）明显长于第2组。
虽然对PONV没有有益影响，但早期给予芬太尼可使正常呼吸和意识的恢复更快。苏醒期谵妄得到了良好控制，与手术结束时给予芬太尼的情况相似。
1b 《喉镜》，2020年
