Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.
Department of Anesthesiology, Cathy General Hospital, Taipei, Taiwan.
Asian J Anesthesiol. 2020 Jun 1;58(2):64-71. doi: 10.6859/aja.202006_58(2).0004.
Reducing anesthesia-controlled time (ACT) such as extubation time may improve operation room (OR) efficiency result from different anesthetic techniques. However, the information about the difference in ACT between desflurane (DES) anesthesia and propofol-based total intravenous anesthesia (TIVA) techniques for open liver resection under general anesthesia is not available in the literature.
This retrospective study uses our hospital database to analyze the ACT of open liver resection after either DES/fentanyl-based anesthesia or TIVA via target-controlled infusion (TCI) with fentanyl/propofol from January 2010 to December 2011. The various time intervals including waiting for anesthesia time, anesthesia time, surgical time, extubation time, exit from OR after extubation, total OR time, and post-anesthetic care unit stay time and percentage of prolonged extubation (≥ 15 minutes) were compared between the two anesthetic techniques.
We included 143 hepatocellular carcinoma patients, with 82 patients receiving TIVA and 61 patients receiving DES. The extubation time was faster (10.1 ± 3.2 min vs. 11.8 ± 5.2 min; P = 0.03), and the incidence of prolonged extubation was lower (9.8% vs. 26.8%; P = 0.02) in the DES group than in the TIVA group. The factors contributed to prolonged extubation were age, sex, anesthetic technique, and anesthesia time.
The DES anesthesia provided faster extubation time and lower incidence of prolonged extubation compared with propofol-based TIVA by TCI in elective open liver resection. Besides, older age, male, TIVA, and lengthy anesthesia time were factors affecting prolonged extubation.
通过不同的麻醉技术，减少麻醉控制时间（ACT），如拔管时间，可能会提高手术室（OR）效率。然而，关于全身麻醉下开腹肝切除术中地氟烷（DES）麻醉与依托咪酯为基础的全静脉麻醉（TIVA）技术之间 ACT 差异的信息在文献中尚不清楚。
本回顾性研究使用我院数据库，分析 2010 年 1 月至 2011 年 12 月期间接受 DES/芬太尼为基础的麻醉或依托咪酯为基础的 TCI 联合芬太尼/丙泊酚的开腹肝切除患者的 ACT。比较两种麻醉技术的各种时间间隔，包括麻醉等待时间、麻醉时间、手术时间、拔管时间、拔管后离开 OR 时间、总 OR 时间、麻醉后监护室停留时间和延长拔管时间（≥15 分钟）的比例。
共纳入 143 例肝细胞癌患者，其中 82 例接受 TIVA，61 例接受 DES。DES 组的拔管时间更快（10.1±3.2 min 比 11.8±5.2 min；P=0.03），延长拔管的发生率更低（9.8%比 26.8%；P=0.02）。延长拔管的因素为年龄、性别、麻醉技术和麻醉时间。
与依托咪酯为基础的 TCI 相比，全身麻醉下开腹肝切除术中，DES 麻醉可更快地拔管，延长拔管的发生率更低。此外，年龄较大、男性、TIVA 和较长的麻醉时间是影响延长拔管的因素。
