Zhu Lin-Jia, Zhang Si-Bi, Jiang Xiu-Hong, Ni Yan
Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
Ann Palliat Med. 2021 Feb;10(2):1207-1215. doi: 10.21037/apm-20-1146. Epub 2020 Oct 9.
To guarantee efficient operating room (OR) activity, tracheal extubation is often performed in the postanesthesia care unit (PACU). Therefore, the ability of PACU to accommodate postoperative patients is crucial. Optimizing extubation management may speed up the turnover of PACU beds. The aim of the present study was to investigate the effect of remifentanil, which is used during analepsia, on the length of PACU stay in patients undergoing laparoscopic surgery for endometrial cancer.
In this prospective trial, we recruited a total of 99 patients, who were scheduled for laparoscopic surgery for endometrial cancer. At the end of the surgery, all patients were immediately transferred to the PACU and continued mechanical ventilation. Upon PACU admission, sputum aspiration was routinely performed. If the hemodynamic parameters fluctuated >30% of the baseline level, or patients moved unconsciously without reaching the criteria of extubation, a bolus injection of either 1 μg/kg remifentanil (Rem group, n=51) or propofol 1.0 mg/kg (Pro group, n=48) was randomly administered. The primary outcome was the duration of PACU stay. The secondary outcomes included time to respiratory breath recovery and time to extubation, along with bispectral index (BIS) values and hemodynamic status after remifentanil or propofol intervention. Times of repeated intervention, rescue administration of vasoactive drugs, and the incidence of adverse events were recorded. Visual analog scale and satisfaction scores at the time of PACU discharge were also evaluated.
The duration of PACU stay was shorter in the Rem group than in the Pro group [49 (46.47-51.06 minutes) vs. 62 minutes (60.75-69.29 minutes), P<0.0001]. Compared with the Pro group, the time to spontaneous breathing recovery, the time to extubation, and the incidence of hypoxemia after extubation were reduced in the Rem group (P<0.0001, P<0.0001, P=0.03, respectively). After anesthetic administration, the BIS value decreased less in the Rem group (P<0.0001); blood pressure and heart rate (HR) declined, but were comparable in both groups.
Remifentanil, which is injected during analepsia, significantly shortens the duration of PACU stay without increasing adverse events in the peri-extubation period.
为确保手术室（OR）高效运转，气管拔管通常在麻醉后护理单元（PACU）进行。因此，PACU容纳术后患者的能力至关重要。优化拔管管理可能会加快PACU床位的周转。本研究的目的是探讨苏醒期使用瑞芬太尼对子宫内膜癌腹腔镜手术患者在PACU停留时间的影响。
在这项前瞻性试验中，我们共招募了99例计划进行子宫内膜癌腹腔镜手术的患者。手术结束时，所有患者立即转入PACU并继续机械通气。进入PACU后，常规进行吸痰。如果血流动力学参数波动超过基线水平的30%，或者患者无意识地活动且未达到拔管标准，则随机给予1 μg/kg瑞芬太尼推注（瑞芬太尼组，n = 51）或丙泊酚1.0 mg/kg（丙泊酚组，n = 48）。主要结局是PACU停留时间。次要结局包括呼吸恢复时间、拔管时间，以及瑞芬太尼或丙泊酚干预后的脑电双频指数（BIS）值和血流动力学状态。记录重复干预次数、血管活性药物的抢救使用情况以及不良事件的发生率。还评估了PACU出院时的视觉模拟量表评分和满意度评分。
瑞芬太尼组的PACU停留时间比丙泊酚组短[49（46.47 - 51.06分钟）vs. 62分钟（60.75 - 69.29分钟），P < 0.0001]。与丙泊酚组相比，瑞芬太尼组的自主呼吸恢复时间、拔管时间以及拔管后低氧血症的发生率均降低（分别为P < 0.0001、P <
