地氟醚麻醉与全静脉麻醉对斜视矫正术后日间手术麻醉控制手术室时间的比较：一项随机对照研究。

Desflurane anesthesia compared with total intravenous anesthesia on anesthesia-controlled operating room time in ambulatory surgery following strabotomy: a randomized controlled study.

机构信息

Department of Anesthesiology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, China.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, China.

出版信息

Chin Med J (Engl). 2020 Apr 5;133(7):779-785. doi: 10.1097/CM9.0000000000000728.

DOI:10.1097/CM9.0000000000000728

PMID:32149764

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7147648/

Abstract

BACKGROUND

Ophthalmic ambulatory surgery is preferred to be performed under general anesthesia either by total intravenous anesthesia (TIVA) or by inhalational anesthesia to increase the patient comfort. However, anesthesia-controlled time (ACT) can cause increased non-operative operating room (OR) time which may adversely affect the ORs efficiency. This study was aimed to compare the ACT of desflurane with that of propofol-remifentanil in strabismus ambulatory surgery.

METHODS

From November 2016 to December 2017, a total of 200 strabismus patients (aged 18-60 years old, and scheduled for elective ambulatory surgery at Zhongshan Ophthalmic Center) were randomly assigned to receive either propofol-based TIVA (group TIVA) or desflurane anesthesia (group DES) for maintenance of anesthesia. The primary outcome was the extubation time. Secondary outcomes included surgical time, anesthetic time, OR exit time, and Phase I and II recovery time. The intraoperative incidences of hypotension, bradycardia and oculocardiac reflex (OCR), and the incidences of any post-operative complications were recorded. Mann-Whitney U test and Chi-square or Fisher exact tests were used to compare the two groups.

RESULTS

We found that the extubation time (5.5 [3.9-7.0] vs. 9.7 [8.5-11.4] min, P < 0.001) and the incidence of prolonged time to extubation (0 vs. 6%, P = 0.029) in the DES group were significantly decreased compared with those in the TIVA group. The patients in the DES group displayed shorter OR exit time as compared with that in the TIVA group (7.3 [5.5-8.7] vs. 10.8 [9.3-12.3] min, P < 0.001). The patients using desflurane exhibited more stable hemodynamics during surgery than the patients using propofol-based TIVA, as demonstrated by lower incidences of hypotension (1% vs. 22%, P < 0.001), bradycardia (2% vs. 13%, P = 0.002), and OCR (17% vs. 44%, P < 0.001).

CONCLUSION

DES enhanced the ophthalmic OR efficiency by reducing the extubation time and OR exit time, and provided more stable hemodynamics intra-operatively than TIVA in patients undergoing strabismus ambulatory surgery.

TRIAL REGISTRATION

ClinicalTrials.gov, No. NCT02922660; https://clinicaltrials.gov/ct2/show/NCT02922660?id=NCT02922660&draw=2&rank=1.

摘要

背景

眼科门诊手术更倾向于在全身麻醉下进行，无论是全凭静脉麻醉（TIVA）还是吸入麻醉，以增加患者的舒适度。然而，麻醉控制时间（ACT）可能会导致非手术手术室（OR）时间延长，从而对 OR 的效率产生不利影响。本研究旨在比较地氟醚与丙泊酚-瑞芬太尼在斜视门诊手术中的 ACT。

方法

2016 年 11 月至 2017 年 12 月，共 200 例斜视患者（年龄 18-60 岁，择期在中山眼科中心行门诊手术）被随机分为接受丙泊酚 TIVA（TIVA 组）或地氟醚麻醉（DES 组）维持麻醉。主要结局为拔管时间。次要结局包括手术时间、麻醉时间、OR 出口时间以及第 I 期和第 II 期恢复时间。记录术中低血压、心动过缓、眼心反射（OCR）的发生率以及任何术后并发症的发生率。采用 Mann-Whitney U 检验和卡方检验或 Fisher 确切概率法比较两组。

结果

与 TIVA 组相比，DES 组的拔管时间（5.5[3.9-7.0] vs. 9.7[8.5-11.4]min，P<0.001）和拔管时间延长的发生率（0 与 6%，P=0.029）显著降低。DES 组的 OR 出口时间明显短于 TIVA 组（7.3[5.5-8.7] vs. 10.8[9.3-12.3]min，P<0.001）。与使用丙泊酚 TIVA 的患者相比，使用地氟醚的患者术中血流动力学更稳定，表现为低血压发生率（1%与 22%，P<0.001）、心动过缓发生率（2%与 13%，P=0.002）和 OCR 发生率（17%与 44%，P<0.001）较低。