Wu Yu-Ming, Su Yen-Hao, Huang Shih-Yu, Lo Po-Han, Chen Jui-Tai, Chang Hung-Chi, Yang Yun-Ling, Cherng Yih-Giun, Wu Hsiang-Ling, Tai Ying-Hsuan
Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
J Clin Med. 2021 Dec 29;11(1):162. doi: 10.3390/jcm11010162.
Obesity increases the risk of prolonged emergence from general anesthesia due to the delayed release of anesthetic agents from body fat. This trial aimed to evaluate the effects of sevoflurane and desflurane along with anesthetic depth monitoring on emergence time from anesthesia in obese patients. Adults with a body mass index ≥ 30 kg·m undergoing laparoscopic sleeve gastrectomy at a medical center were randomized into four groups: sevoflurane or desflurane anesthesia with or without M-Entropy guidance on anesthetic depth in a ratio of 1:1:1:1. In the M-Entropy guidance groups, the dosage of sevoflurane and desflurane was adjusted to achieve response and state entropy values between 40 and 60 during surgery. In the non-M-Entropy guidance groups, the dosage of anesthetics was titrated according to clinical signs. Primary outcome was time to spontaneous eye opening. A total of 80 participants were randomized. Compared to sevoflurane, desflurane anesthesia significantly reduced the time to spontaneous eye opening [mean difference (MD): -129 s; 95% confidence interval (CI): -211, -46], obeying commands (-160; -243, -77), tracheal extubation (-172; -266, -78), and leaving operating room (-148; -243, -54). M-Entropy guidance further reduced time to eye opening (MD: -142 s; 99.2% CI: -276, -8), tracheal extubation (-199; -379, -19), and leaving operating room (-190; -358, -23) in the desflurane but not the sevoflurane group. M-Entropy guidance significantly reduced the risk of agitation during emergence, i.e., risk difference: -0.275 (95% CI: -0.464, -0.086); and number needed to treat: 4. Compared to sevoflurane, using desflurane to maintain general anesthesia accelerated the return of consciousness in obese patients. M-Entropy guidance further hastened awakening in patients using desflurane and prevented emergence agitation.
肥胖会增加全身麻醉后苏醒延迟的风险，这是由于麻醉剂从体内脂肪中释放延迟所致。本试验旨在评估七氟烷和地氟烷以及麻醉深度监测对肥胖患者麻醉苏醒时间的影响。在某医疗中心接受腹腔镜袖状胃切除术、体重指数≥30kg·m²的成年人被随机分为四组：七氟烷或地氟烷麻醉，有无M-熵麻醉深度引导，比例为1:1:1:1。在M-熵引导组中，七氟烷和地氟烷的剂量在手术期间进行调整，以使反应熵和状态熵值在40至60之间。在非M-熵引导组中，麻醉剂剂量根据临床体征进行滴定。主要结局是自主睁眼时间。共有80名参与者被随机分组。与七氟烷相比，地氟烷麻醉显著缩短了自主睁眼时间[平均差(MD)：-129秒；95%置信区间(CI)：-211，-46]、能听从指令时间(-160；-243，-77)、气管拔管时间(-172；-266，-78)和离开手术室时间(-148；-243，-54)。M-熵引导在使用地氟烷的组中进一步缩短了睁眼时间(MD：-142秒；99.2%CI：-276，-8)、气管拔管时间(-199；-379，-19)和离开手术室时间(-190；-358，-23)，但在七氟烷组中未出现此效果。M-熵引导显著降低了苏醒期躁动的风险，即风险差：-0.275(95%CI：-0.464，-0.086)；治疗所需人数：4。与七氟烷相比，使用地氟烷维持全身麻醉可加速肥胖患者意识恢复。M-熵引导进一步加快了使用地氟烷患者的苏醒速度，并预防了苏醒期躁动。
