丙泊酚-右美托咪定静脉麻醉与七氟醚吸入麻醉用于改良根治性乳房切除术患者的比较

Comparison of Propofol-Dexmedetomidine-Based Intravenous and Sevoflurane-Based Inhalational Anesthesia in Patients Undergoing Modified Radical Mastectomy.

作者信息

Goel Nitesh, Jha Rupam, Bhardwaj Manoj, Chawla Rajiv

机构信息

Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.

出版信息

Anesth Essays Res. 2020 Jul-Sep;14(3):420-424. doi: 10.4103/aer.AER_13_21. Epub 2021 Mar 22.

DOI:10.4103/aer.AER_13_21

PMID:34092852

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8159053/

Abstract

BACKGROUND AND AIM

Total intravenous anesthesia (TIVA) has proven advantage over inhalational anesthesia in terms of stable hemodynamic, eco-friendly, and good recovery profile, but apprehension regarding adequate depth of anesthesia and intraoperative recall is still pertaining. This study aims to compare propofol-dexmedetomidine-based TIVA with sevoflurane-based inhalational anesthesia in modified radical mastectomy in terms of depth of anesthesia, intraoperative recall, recovery profile, and hemodynamic status.

SETTINGS AND DESIGN

This prospective randomized controlled study was conducted at a tertiary care center over a time frame of 1 year.

METHODOLOGY

In this randomized controlled study, 100 patients were randomly distributed into two groups: TIVA (Group T) and inhalational anesthesia (Group I). Group T patients received injection dexmedetomidine: 1 μg.kg over 10 min followed by 0.7 μg.kg.h and injection propofol: 25-100 μg.kg.min. Ventilation was maintained with oxygen-air gas flow. In Group I, patients were ventilated with nitrous oxide-oxygen (50:50) and sevoflurane. Rest of anesthesia for both the groups was same. Primary objective was to achieve adequate depth of anesthesia as monitored by intraoperative bispectral index value (BIS, 40-60). Hemodynamic variables, recovery profile, and amount of individual anesthetic agent consumed were recorded for comparison between two groups. For comparison of scale variables between two groups, independent sample -test for significant difference between two sample means has been followed.

RESULTS

Intraoperative BIS and hemodynamic variables were comparable ( > 0.05). Emergence time was 5.10 min in the TIVA group versus 8.38 min in the inhalational group ( = 0.00). Modified Aldrete score was comparable in two groups ( > 0.05). Cost of TIVA agents consumed per patient was 40% lesser than inhalational agents.

CONCLUSION

TIVA maintains adequate depth of anesthesia along with stable hemodynamic and good recovery profile, at low cost in an eco-friendly manner.

摘要

背景与目的

全凭静脉麻醉（TIVA）在血流动力学稳定、环保以及恢复良好等方面已被证明优于吸入麻醉，但对于麻醉深度是否足够以及术中知晓的担忧仍然存在。本研究旨在比较丙泊酚 - 右美托咪定复合的全凭静脉麻醉与七氟醚吸入麻醉用于改良根治性乳房切除术时的麻醉深度、术中知晓、恢复情况及血流动力学状态。

设置与设计

本前瞻性随机对照研究在一家三级医疗中心进行，为期1年。

方法

在这项随机对照研究中，100例患者被随机分为两组：全凭静脉麻醉组（T组）和吸入麻醉组（I组）。T组患者静脉注射右美托咪定：1 μg/kg，持续10分钟，随后以0.7 μg·kg⁻¹·h维持，同时静脉注射丙泊酚：25 - 100 μg·kg⁻¹·min。采用氧气 - 空气混合气流维持通气。I组患者采用氧化亚氮 - 氧气（50:50）和七氟醚通气。两组其余麻醉处理相同。主要目标是通过术中脑电双频指数值（BIS，40 - 60）监测达到足够的麻醉深度。记录血流动力学变量、恢复情况以及个体麻醉药消耗量，用于两组间比较。对于两组间量表变量的比较，采用独立样本t检验以比较两个样本均数之间的显著差异。