Sanchez Antoine, Chrusciel Jan, Cimino Yann, Nguyen Maxime, Guinot Pierre-Grégoire, Sanchez Stéphane, Bouhemad Belaid
Department of Anaesthesiology and Intensive Care, C.H.U. Dijon, 21709 Dijon, France.
Department of Public Health and Performance, CH Troyes, 10003 Troyes, France.
Healthcare (Basel). 2022 Feb 7;10(2):313. doi: 10.3390/healthcare10020313.
Ultrasound-guided axillary brachial plexus block (ABPB) is a technique of choice for regional anesthesia during hand and forearm surgery. Intravenous sedation may facilitate this procedure, particularly for those suffering from anxiety; however, it can also be associated with respiratory, cardiovascular, and neurological side effects. The objective of this study was to evaluate the effect of intravenous sedation on perioperative respiratory depression for patients undergoing day-case hand surgery under ABPB.
A prospective, observational, single-center study was conducted between 1 May and 1 November 2016.
A total of 2318 patients were included, with 501 patients in the group with IV sedation and 1817 in the group without. A multivariable propensity-score matched analysis showed that the variables associated with the number of desaturation were: (i) sedation (aRR 1.534 [95% CI: 1.283 to 1.836]), (ii) age and sex, (iii) type of surgery, and iv) Body Mass Index (BMI).
Supplementing ABPB with IV sedation was associated with an increased rate of respiratory depression (episodes of desaturation) compared to fully awakened patients. The rate of oxygen administration was also higher in sedated patients even though they had fewer cases of chronic respiratory diseases and fewer were active smokers than non-sedated patients. Future research should consider precisely evaluating patient satisfaction, as well as the differences between sedation and drug-free approaches.
超声引导下腋路臂丛神经阻滞（ABPB）是手部和前臂手术区域麻醉的首选技术。静脉镇静可使该操作更顺利，尤其是对焦虑患者；然而，它也可能伴有呼吸、心血管和神经方面的副作用。本研究的目的是评估静脉镇静对接受ABPB日间手部手术患者围手术期呼吸抑制的影响。
2016年5月1日至11月1日进行了一项前瞻性、观察性、单中心研究。
共纳入2318例患者，其中静脉镇静组501例，未镇静组1817例。多变量倾向评分匹配分析显示，与去饱和次数相关的变量有：（i）镇静（调整后风险比1.534 [95%置信区间：1.283至1.836]），（ii）年龄和性别，（iii）手术类型，以及（iv）体重指数（BMI）。
与完全清醒的患者相比，ABPB联合静脉镇静与呼吸抑制（去饱和发作）发生率增加有关。尽管镇静患者的慢性呼吸系统疾病病例较少且吸烟者比未镇静患者少，但镇静患者的吸氧率也更高。未来的研究应考虑精确评估患者满意度，以及镇静与无药方法之间的差异。
