Pluta Aleksandra, Stasiowski Michał Jan, Lyssek-Boroń Anita, Król Seweryn, Krawczyk Lech, Niewiadomska Ewa, Żak Jakub, Kawka Magdalena, Dobrowolski Dariusz, Grabarek Beniamin Oskar, Szumera Izabela, Missir Anna, Rejdak Robert, Jałowiecki Przemysław
Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-200 Sosnowiec, Poland.
Department of Anaesthesiology and Intensive Therapy, 5th Regional Hospital, 41-200 Sosnowiec, Poland.
J Clin Med. 2021 Sep 15;10(18):4172. doi: 10.3390/jcm10184172.
The intraprocedural immobilization of selected subsets of patients undergoing pars plana vitrectomy (PPV) requires the performance of general anesthesia (GA), which entails the intraoperative use of hypnotics and titration of opioids. The Adequacy of Anesthesia (AoA) concept of GA guidance optimizes the intraoperative dosage of hypnotics and opioids. Pre-emptive analgesia (PA) is added to GA to minimize intraoperative opioid (IO) usage. The current additional analysis evaluated the advantages of PA using either COX-3 inhibitors or regional techniques when added to AoA-guided GA on the rate of presence of postoperative nausea and vomiting (PONV), oculo-emetic (OER), and oculo-cardiac reflex (OCR) in patients undergoing PPV. A total of 176 patients undergoing PPV were randomly allocated into 5 groups: (1) Group GA, including patients who received general anesthesia alone; (2) Group T, including patients who received preventive topical analgesia by triple instillation of 2% proparacaine 15 min before induction of GA; (3) Group PBB, including patients who received PBB; (4) Group M, including patients who received PA using a single dose of 1 g of metamizole; (5) Group P, including patients who received PA using a single dose of 1 g of acetaminophen. The incidence rates of PONV, OCR, and OER were studied as a secondary outcome. Despite the group allocation, intraoperative AoA-guided GA resulted in an overall incidence of PONV in 9%, OCR in 12%, and OER in none of the patients. No statistically significant differences were found between groups regarding the incidence of OCR. PA using COX-3 inhibitors, as compared to that of the T group, resulted in less overall PONV ( < 0.05). Conclusions: PA using regional techniques in patients undergoing PPV proved to have no advantage when AoA-guided GA was utilised. We recommend using intraoperative AoA-guided GA to reduce the presence of OCR, and the addition of PA using COX-3 inhibitors to reduce the rate of PONV.
在接受玻璃体切割术（PPV）的部分患者中，术中固定需要实施全身麻醉（GA），这需要在术中使用催眠药并滴定阿片类药物。GA引导下的麻醉充分性（AoA）概念可优化催眠药和阿片类药物的术中剂量。在GA基础上加用超前镇痛（PA）以尽量减少术中阿片类药物（IO）的使用。当前的附加分析评估了在接受PPV的患者中，当在AoA引导的GA基础上加用COX-3抑制剂或区域技术进行PA时，对术后恶心呕吐（PONV）、眼心反射（OCR）和眼呕吐反射（OER）发生率的影响。总共176例接受PPV的患者被随机分为5组：（1）GA组，包括仅接受全身麻醉的患者；（2）T组，包括在GA诱导前15分钟通过三联滴注2%丙美卡因接受预防性局部镇痛的患者；（3）PBB组，包括接受PBB的患者；（4）M组，包括使用单剂量1g安乃近进行PA的患者；（5）P组，包括使用单剂量1g对乙酰氨基酚进行PA的患者。将PONV、OCR和OER的发生率作为次要结果进行研究。尽管进行了分组，但术中AoA引导的GA导致PONV的总体发生率为9%，OCR为12%，且无患者发生OER。各组之间在OCR发生率方面未发现统计学上的显著差异。与T组相比，使用COX-3抑制剂进行PA导致总体PONV较少（<0.05）。结论：在使用AoA引导的GA时，在接受PPV的患者中使用区域技术进行PA没有优势。我们建议使用术中AoA引导的GA以减少OCR的发生，并加用使用COX-3抑制剂的PA以降低PONV的发生率。
