Zhang Xiao, Qi Siyi, Lin Zhen, Zhang Yizhe, Dai Wanbing, Tian Weitian, Tian Jie, Zheng Li, Su Diansan, Huai Xiaorong
Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Anesthesiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China.
Front Psychiatry. 2023 Jan 17;13:1090149. doi: 10.3389/fpsyt.2022.1090149. eCollection 2022.
This study explored the effectiveness of pre-operative intravenous injection of butorphanol in the alleviation of emergence agitation (EA) in patients undergoing functional endoscopic sinus surgery (FESS).
Patients ( = 708) were randomized into two groups. The butorphanol group (Group B, = 358) received butorphanol infusion (20 ug/kg) before anesthesia induction, while the control group (Group C, = 350) received an equal volume of normal saline infusion. General anesthesia was induced with sufentanil, propofol, and rocuronium, and was maintained with sevoflurane and remifentanil. Vasoactive drugs maintained the hemodynamic indices within 20% of the baseline.
The incidence of EA was significantly lower in Group B than that in Group C (Group B vs. C: 24.3% vs. 31.4%, respectively; = 0.034). The times to spontaneous breathing (26.5 min vs. 23.7 min, = 0.011), verbal response (36.0 min vs. 33.4 min, = 0.012), and extubation (31.0 min vs. 28.7 min, = 0.025) were longer in Group B, and the grade of cough (0.33 vs. 0.43, = 0.024) at extubation in Group B was lower than that in Group C ( = 0.024). The mean arterial pressure at the end of the operation ( = 0.004) and at 5 min after extubation ( = 0.008) was higher and hypotension was less prominent (0.6% vs. 2.6%, = 0.030) in Group B.
Pre-operative intravenous injection of butorphanol decreased the incidence of EA after FESS and provided smooth and hemodynamically stable emergence without extending the stay in post-anesthesia care unit.
https://www.clinicaltrials.gov/, identifier NCT03398759.
本研究探讨术前静脉注射布托啡诺对减轻功能性鼻内镜鼻窦手术（FESS）患者苏醒期躁动（EA）的效果。
将708例患者随机分为两组。布托啡诺组（B组，n = 358）在麻醉诱导前接受布托啡诺输注（20μg/kg），而对照组（C组，n = 350）接受等体积的生理盐水输注。采用舒芬太尼、丙泊酚和罗库溴铵诱导全身麻醉，并用七氟醚和瑞芬太尼维持麻醉。血管活性药物使血流动力学指标维持在基线的20%以内。
B组EA的发生率显著低于C组（B组与C组分别为24.3%和31.4%；P = 0.034）。B组自主呼吸恢复时间（26.5分钟对23.7分钟，P = 0.011）、言语应答时间（36.0分钟对33.4分钟，P = 0.012）和拔管时间（31.0分钟对28.7分钟，P = 0.025）更长，且B组拔管时咳嗽程度（0.33对0.43，P = 0.024）低于C组（P = 0.024）。B组手术结束时（P = 0.004）和拔管后5分钟（P = 0.008）的平均动脉压更高，低血压情况不那么明显（0.6%对2.6%，P = 0.030）。
术前静脉注射布托啡诺可降低FESS术后EA的发生率，并使苏醒过程平稳、血流动力学稳定，且不延长在麻醉后护理单元的停留时间。
