Hu Huimin, Niu Zheng, Song Jie, Wang Ting, Qi Dunyi
Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, China.
Department of Anaesthesia, Suzhou Municipal Hospital, China.
Indian J Anaesth. 2025 Sep;69(9):909-917. doi: 10.4103/ija.ija_105_25. Epub 2025 Aug 12.
As gynaecological laparoscopic minimally invasive surgery continues to advance, it becomes essential to explore how inhalation anaesthesia and intravenous anaesthesia affect the recovery of gastrointestinal function after surgery. The objective was to compare the effects of total intravenous anaesthesia (TIVA) and inhalation anaesthesia on the time of the first defecation and the time of consuming solid food for patients following laparoscopic total hysterectomy.
This research involved 134 female participants aged 18-65 years, classified as American Society of Anesthesiologists physical status I-II, who were scheduled to undergo elective laparoscopic hysterectomy procedures. Participants were randomly allocated into two cohorts: one receiving TIVA (Group P) (underwent TIVA induction with propofol, remifentanil, and rocuronium administration, supplemented by ongoing administration of propofol-remifentanil infusions), and the other group was administered inhalational anaesthesia (Group S) (using sevoflurane delivered through precise tidal volume ventilation alongside rocuronium, with maintenance achieved through combined sevoflurane inhalation and remifentanil infusion). The primary outcome was the time to initial defecation and tolerance of solid food (SF + D), while the final outcome was determined by the longer duration required to achieve these two outcomes. The I-FEED (intake, feeling nauseated, emesis, physical examination, and duration of symptoms) score, the numeric rating scale score for pain, and the numeric rating scale score for postoperative nausea and vomiting, the time to first flatus, gastric antral motility index, and intestinal peristalsis rate within 1 minute determined by bedside ultrasound were also recorded.
The mean to first defecation + hard food tolerance (SF + D) was 51 [standard deviation (SD: 8.47)] in Group S and 47 (SD: 9.45) in Group P ( = 0.02), and the mean difference between the groups was - 4.46 (95% CI: 0.20, 7.00). None of the I-FEED scores were statistically significant ( = 0.074, = -1.79). Patients in Group P experienced superior analgesic effects and more stable haemodynamics.
The postoperative recovery of gastrointestinal function can be enhanced by employing total intravenous anaesthesia instead of inhalation anaesthesia.
随着妇科腹腔镜微创手术的不断发展，探讨吸入麻醉和静脉麻醉对术后胃肠功能恢复的影响变得至关重要。目的是比较全静脉麻醉（TIVA）和吸入麻醉对腹腔镜全子宫切除术后患者首次排便时间和食用固体食物时间的影响。
本研究纳入了134名年龄在18 - 65岁之间、美国麻醉医师协会身体状况分级为I - II级的女性参与者，她们计划接受择期腹腔镜子宫切除术。参与者被随机分为两组：一组接受全静脉麻醉（P组）（采用丙泊酚、瑞芬太尼和罗库溴铵进行全静脉麻醉诱导，并持续输注丙泊酚 - 瑞芬太尼），另一组接受吸入麻醉（S组）（通过精确潮气量通气给予七氟醚，同时使用罗库溴铵，并通过七氟醚吸入和瑞芬太尼输注维持麻醉）。主要结局指标是首次排便时间和对固体食物的耐受时间（SF + D），最终结局指标由达到这两个结局所需的较长时间决定。还记录了I - FEED（摄入、恶心、呕吐、体格检查和症状持续时间）评分、疼痛数字评分量表评分、术后恶心呕吐数字评分量表评分、首次排气时间、胃窦蠕动指数以及床边超声测定的1分钟内肠道蠕动率。
S组首次排便 + 固体食物耐受时间（SF + D）的平均值为51 [标准差（SD：8.47）]，P组为47（SD：9.45）（P = 0.02），两组间的平均差异为 - 4.46（95% CI：0.20，7.00）。I - FEED评分均无统计学意义（P = 0.074，t = -1.79）。P组患者的镇痛效果更好，血流动力学更稳定。
采用全静脉麻醉而非吸入麻醉可促进术后胃肠功能的恢复。
