手动和注射器泵诱导全静脉麻醉对异丙酚浪费的影响：单中心回顾性分析。

Effects of manual and syringe pump induction of total intravenous anaesthesia on propofol waste: a single-centre retrospective analysis.

机构信息

Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.

出版信息

Br J Anaesth. 2024 Dec;133(6):1459-1464. doi: 10.1016/j.bja.2024.10.002. Epub 2024 Oct 29.

DOI:10.1016/j.bja.2024.10.002

PMID:39472186

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11589471/

Abstract

BACKGROUND

Propofol accounts for a substantial proportion of medication waste. Evidence-based waste reduction methods are scarce.

METHODS

In a retrospective analysis of 331 procedures, the total propofol waste per surgery was compared between manual and syringe pump induction of anaesthesia during total intravenous anaesthesia (TIVA), with a syringe pump used to maintain TIVA after induction. The secondary endpoint was the amount of propofol administered. Subgroup analyses examined the influence of biological sex, age, weight or BMI, American Society of Anesthesiologists (ASA) physical status, substance use, and anaesthesia duration on propofol waste.

RESULTS

Syringe pump induction was associated with 32.8% less waste of propofol (P<0.001); this effect was most pronounced in procedures lasting 20-60 min (up to 46.9% less in procedures lasting 20-40 min, P<0.001) and 80-120 min (up to 48.8% less in procedures lasting 100-120 min, P=0.003). The amount of waste was not affected by biological sex, age, weight, BMI, or ASA physical status. Syringe pump induction was consistently associated with less waste, except in patients with obesity. Patients with active substance use had 27.6% more waste with manual induction (P=0.031) but not with syringe pump induction. In patients with and without active substance use, syringe pump induction resulted in less waste (substance use: 48.7% less, P=0.0015; without substance use: 22.7% less, P=0.0045).

CONCLUSIONS

Syringe pump induction reduced propofol waste during TIVA, regardless of patient characteristics. Manual induction using a separate syringe should be reconsidered from an environmental and economic viewpoint.

CLINICAL TRIAL REGISTRATION

DRKS00032518I.

摘要

背景

异丙酚占药物浪费的很大一部分。目前缺乏基于证据的减少浪费的方法。

方法

在 331 例手术的回顾性分析中，比较了在全静脉麻醉（TIVA）中使用手动和注射器泵诱导麻醉时每例手术的异丙酚总浪费量，使用注射器泵在诱导后维持 TIVA。次要终点是给予的异丙酚量。亚组分析检查了生物性别、年龄、体重或 BMI、美国麻醉医师协会（ASA）身体状况、物质使用和麻醉持续时间对异丙酚浪费的影响。

结果

与手动诱导相比，注射器泵诱导可减少 32.8%的异丙酚浪费（P<0.001）；这种效果在持续 20-60 分钟的手术中最为明显（持续 20-40 分钟的手术中减少 46.9%，P<0.001）和 80-120 分钟（持续 100-120 分钟的手术中减少 48.8%，P=0.003）。浪费量不受生物性别、年龄、体重、BMI 或 ASA 身体状况的影响。除肥胖患者外，注射器泵诱导始终与更少的浪费相关。有物质使用的患者手动诱导时浪费增加 27.6%（P=0.031），但注射器泵诱导时则不然。在有和没有物质使用的患者中，注射器泵诱导可减少浪费（物质使用：减少 48.7%，P=0.0015；无物质使用：减少 22.7%，P=0.0045）。