Department of Anesthesiology, Jundiaí Medical School, Jundiaí, SP, Brazil.
Department of Obstetrics and Gynecology, Jundiaí Medical School, Jundiaí, SP, Brazil.
PLoS One. 2020 Feb 27;15(2):e0228805. doi: 10.1371/journal.pone.0228805. eCollection 2020.
The two most common general anesthesia techniques are total intravenous anesthesia (TIVA) and venous/inhalation balanced general anesthesia (BGA). It is unclear whether any of these two techniques affect patient perception of the quality of recovery. The aim of this randomized, double-blinded clinical trial was to assess the quality of postoperative recovery of women undergoing laparoscopic cholecystectomy under general anesthesia. We compared patients who received TIVA with those who received BGA. We also evaluated the factors that may decrease patient-perceived quality of postoperative recovery.
We prospectively recruited 121 women aged 18-65 years who were scheduled for elective laparoscopic cholecystectomy due to cholelithiasis. These patients were randomized to receive TIVA (target-controlled infusion of propofol and remifentanil) or BGA (continuous remifentanil infusion and sevoflurane inhalation). To measure the quality of postanesthetic and postoperative recovery, we administered the Quality of Recovery-40 (QoR-40) questionnaire 24 hours after the patient awoke from anesthesia.
All 60 patients in the TIVA group responded to QoR-40 (median, 188 points; minimum 128; maximum 200). Sixty-one patients in the BGA group had a mean QoR-40 score of 186 points (median, 188 points; minimum 146; maximum 200). There was no significant difference in the QoR-40 score between the two groups (p = 0.577). The patients who presented postoperative nausea and vomiting (PONV) and pain had worse perception of the quality of postoperative recovery.
Both TIVA and BGA had a similar effect on the perception of the quality of postoperative recovery in women undergoing elective laparoscopic cholecystectomy. PONV and pain may negatively affect patient perception of the quality of postoperative recovery.
全身麻醉最常用的两种技术是全凭静脉麻醉（TIVA）和静脉/吸入平衡全身麻醉（BGA）。目前尚不清楚这两种技术中的任何一种是否会影响患者对恢复质量的感知。本随机、双盲临床试验旨在评估全身麻醉下接受腹腔镜胆囊切除术的女性术后恢复质量。我们比较了接受 TIVA 的患者和接受 BGA 的患者。我们还评估了可能降低患者术后恢复质量感知的因素。
我们前瞻性招募了 121 名年龄在 18-65 岁之间的女性患者，这些患者因胆石症而行择期腹腔镜胆囊切除术。这些患者被随机分为接受 TIVA（丙泊酚和瑞芬太尼靶控输注）或 BGA（持续瑞芬太尼输注和七氟醚吸入）。为了测量麻醉后和术后恢复质量，我们在患者从麻醉中醒来后 24 小时使用质量恢复 40 项问卷（QoR-40）进行评估。
TIVA 组的所有 60 名患者对 QoR-40 有反应（中位数为 188 分；最小值为 128 分；最大值为 200 分）。BGA 组的 61 名患者的 QoR-40 平均得分为 186 分（中位数为 188 分；最小值为 146 分；最大值为 200 分）。两组之间的 QoR-40 评分无显著差异（p=0.577）。出现术后恶心和呕吐（PONV）和疼痛的患者对术后恢复质量的感知较差。
在接受择期腹腔镜胆囊切除术的女性中，TIVA 和 BGA 对术后恢复质量的感知均有相似的影响。PONV 和疼痛可能会对患者对术后恢复质量的感知产生负面影响。
