Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
J Clin Pharm Ther. 2021 Dec;46(6):1629-1635. doi: 10.1111/jcpt.13506. Epub 2021 Aug 2.
Optimal airway management is crucial in strabismus surgery due to the inaccessibility of the airway throughout the procedure. Laryngeal mask airway offers advantages over tracheal intubation in ophthalmic surgery as it does not increase the intraocular pressure. The purpose of this study was to determine the median effective dose of propofol required, when combined with 0.2 µg/kg of sufentanil, for smooth insertion of Ambu AuraFlex in the first attempt in children undergoing strabismus surgery, and to compare it with that for Ambu AuraOnce.
Forty-three paediatric patients undergoing strabismus surgery under general anaesthesia were recruited. For induction, the initial dosage of propofol was 2 mg/kg in the AuraOnce group or 3 mg/kg in the AuraFlex group. In accordance with Dixon's up-and-down method, the dose of propofol for consecutive patients in each group was adjusted in increments or decrements of 0.25 mg/kg based on the previous patient's "three-point, six-category scale" response to the first attempt of insertion of the randomized device. Insertion of the device was attempted when the bispectral index was ≤60 for 5 s after propofol administration without the use of neuromuscular blocking agents.
The median effective dose (95% confidence interval) of propofol was significantly lower in the Ambu AuraOnce group than in the Ambu AuraFlex group (1.92 [1.50-2.32] mg/kg vs. 2.98 [2.49-3.94] mg/kg; p = 0.002). The incidence of dislodgement of the device was significantly higher with the use of the Ambu AuraOnce than with the use of AuraFlex (p = 0.023), whereas insignificant differences were observed between the two groups in the incidence of other perioperative adverse events.
Ambu AuraFlex requires a significantly higher dose of propofol for insertion and provides more effective and stable airway management in strabismus surgery than AuraOnce.
由于斜视手术过程中气道无法接近，因此最佳气道管理至关重要。喉罩气道在眼科手术中优于气管插管，因为它不会增加眼内压。本研究的目的是确定在舒芬太尼 0.2μg/kg 联合作用下，丙泊酚的中位有效剂量，用于在第一次尝试中顺利插入 Ambu AuraFlex ，以用于接受斜视手术的儿童，并与 Ambu AuraOnce 进行比较。
招募 43 名接受全身麻醉下斜视手术的小儿患者。对于诱导，AuraOnce 组的初始丙泊酚剂量为 2mg/kg，AuraFlex 组为 3mg/kg。根据 Dixon 的上下法，根据前一位患者对随机设备首次插入的“三点六类量表”反应，每组中连续患者的丙泊酚剂量根据前一位患者的反应进行递增或递减 0.25mg/kg。在丙泊酚给药后，当双频谱指数（bispectral index，BIS）≤60 且无神经肌肉阻滞剂使用时，尝试插入设备，持续 5s。
与 AuraFlex 组相比，AuraOnce 组丙泊酚的中位有效剂量（95%置信区间）显著降低（1.92 [1.50-2.32]mg/kg 比 2.98 [2.49-3.94]mg/kg；p=0.002）。与 AuraFlex 相比，使用 AuraOnce 时设备脱位的发生率明显更高（p=0.023），而两组之间在其他围手术期不良事件的发生率方面无显著差异。
与 AuraOnce 相比，AuraFlex 插入时需要更高剂量的丙泊酚，在斜视手术中提供更有效和稳定的气道管理。
