Xu Xuan, Liu Haodong, Yang Jie, Zhang Maopeng
Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China.
Department of Anesthesia and Operating Room, Baoji Maternal and Child Health Hospital No. 2, East Section of Xinjian Road, Weibin District, Baoji 721000, Shaanxi, China.
Am J Transl Res. 2023 Jul 15;15(7):4658-4667. eCollection 2023.
To compare the safety profiles between propofol and sevoflurane in pediatric anesthesia and to investigate risk factors for postoperative adverse reactions.
The data of 194 children who received surgical treatment in Peking Union Medical College Hospital between January 2019 and May 2022 were analyzed retrospectively. According to the different anesthetic drugs the children received, they were divided into a control group (conventional anesthesia with sevoflurane, n=94) and an observation group (anesthesia with both propofol and sevoflurane, n=100). The two groups were compared in terms of anesthetic effect, heart rate, blood oxygen saturation, Ramsay sedation scale (RSS) score during the recovery of anesthesia, and anesthesia safety. Further, the children were grouped based on RSS score to identify the risk factors for agitation during the recovery of anesthesia via logistics regression.
The onset time of anesthesia, spontaneous breathing recovery time, extubation time, eye opening time and awake time in the observation group were all significantly shorter than those in the control group (P<0.05). At T1 (during anesthesia induction), T2 (after tracheal intubation) and T3 (after extubation), the observation group showed relatively stable heart rate and blood oxygen saturation than the control group (P<0.05). At the time of awakening, extubation and 30 minutes after extubation, the observation group exhibited significantly lower RSS score than the control group (P<0.05). The observation group also showed a significantly lower incidence of nausea, vomiting and agitation than the control group (P<0.05). Additionally, age ≤6 years old and anesthesia scheme were independent risks for agitation in children during the recovery of anesthesia. The occurrence group had significantly higher risk scores than the non-occurrence group (P<0.05). According to receiver operating characteristic curve-based analysis, the area under the curve of risk score in predicting agitation during the recovery of anesthesia was 0.733.
Anesthesia with both propofol and sevoflurane is effective in children undergoing surgical treatment, because the combination can substantially reduce the agitation of children during the recovery of anesthesia and has high anesthesia safety. Propofol combined with sevoflurane is a protective factor against agitation in children during the recovery of anesthesia.
比较丙泊酚和七氟醚在小儿麻醉中的安全性，并探讨术后不良反应的危险因素。
回顾性分析2019年1月至2022年5月在北京协和医院接受手术治疗的194例患儿的数据。根据患儿接受的不同麻醉药物，将其分为对照组（七氟醚常规麻醉，n = 94）和观察组（丙泊酚联合七氟醚麻醉，n = 100）。比较两组的麻醉效果、心率、血氧饱和度、麻醉恢复时的Ramsay镇静评分（RSS）及麻醉安全性。此外，根据RSS评分对患儿进行分组，通过逻辑回归分析确定麻醉恢复时躁动的危险因素。
观察组的麻醉诱导时间、自主呼吸恢复时间、拔管时间、睁眼时间及清醒时间均显著短于对照组（P < 0.05）。在T1（麻醉诱导时）、T2（气管插管后）和T3（拔管后），观察组的心率和血氧饱和度较对照组相对稳定（P < 0.05）。在苏醒时、拔管时及拔管后30分钟，观察组的RSS评分显著低于对照组（P < 0.05）。观察组恶心、呕吐及躁动的发生率也显著低于对照组（P < 0.05）。此外，年龄≤6岁和麻醉方案是小儿麻醉恢复时躁动的独立危险因素。发生组的风险评分显著高于未发生组（P < 0.05）。根据基于受试者工作特征曲线的分析，风险评分预测麻醉恢复时躁动的曲线下面积为0.733。
丙泊酚联合七氟醚麻醉对接受手术治疗的小儿有效，因为该联合用药可显著减少小儿麻醉恢复时的躁动，且麻醉安全性高。丙泊酚联合七氟醚是小儿麻醉恢复时防止躁动的保护因素。
