Ming Wanquan, Cao Yunfei, Xu Xianfei, Ding Miao, Sheng Cheng
Department of Anesthesiology, Ningbo Beilun District People's Hospital, Ningbo, Zhejiang, China.
Department of Anesthesiology, Ningbo Beilun District People's Hospital, Ningbo, Zhejiang, China.
Clinics (Sao Paulo). 2025 Sep 20;80:100764. doi: 10.1016/j.clinsp.2025.100764.
Tracheal intubation surgeries are generally challenging procedures compared to other surgeries. Alfentanil is generally used to treat postoperative pain, but it has respiratory depression. The study examined four anesthetic techniques propofol/alfentanil, sevoflurane/alfentanil, propofol/sevoflurane, and propofol/sevoflurane/alfentanil to see if there is an association with a variety of anesthetic parameters for tracheal intubation surgery while maintaining spontaneous breathing.
In retrospective analyses, patients received intravenous propofol and bolus alfentanil (PA cohort, n = 105) or exposed to sevoflurane gas and received bolus alfentanil (SA cohort, n = 107) or received intravenous propofol and exposed to sevoflurane gas (PS cohort, n = 109) or received intravenous propofol and bolus alfentanil and exposed to sevoflurane gas (SD cohort, n = 02).
Patients of the SD cohort achieved the best airway conditions, characterized by faster loss of eyelash reflex and quicker laryngeal mask insertion. However, patients of the SD cohort also exhibited worse hemodynamic stability, shorter operative times, higher postoperative complications, and prolonged hospital stays. Those results were followed for the patients of the PA, PS, and SA cohorts (p < 0.05 for all comparisons). Patients of the SD cohort required fewer numbers of postoperative administrations of a bolus dose of alfentanil than those of patients of the PS, PA, and SA cohorts (p < 0.05 for all comparisons).
While the propofol-sevoflurane-alfentanil combination improved airway conditions, it caused universal hypotension and frequent bradycardia. Fixed-dose alfentanil (10 µg/kg) without titration may be unsafe in spontaneous breathing protocols due to respiratory depression.
与其他手术相比，气管插管手术通常是具有挑战性的操作。阿芬太尼通常用于治疗术后疼痛，但它有呼吸抑制作用。该研究考察了四种麻醉技术——丙泊酚/阿芬太尼、七氟醚/阿芬太尼、丙泊酚/七氟醚以及丙泊酚/七氟醚/阿芬太尼——在维持自主呼吸的同时，看其与气管插管手术的各种麻醉参数之间是否存在关联。
在回顾性分析中，患者接受静脉注射丙泊酚和推注阿芬太尼（PA组，n = 105），或吸入七氟醚气体并接受推注阿芬太尼（SA组，n = 107），或接受静脉注射丙泊酚并吸入七氟醚气体（PS组，n = 109），或接受静脉注射丙泊酚、推注阿芬太尼并吸入七氟醚气体（SD组，n = 102）。
SD组患者达到了最佳气道条件，其特征为睫毛反射消失更快且喉罩插入更快。然而，SD组患者也表现出更差的血流动力学稳定性、更短的手术时间、更高的术后并发症发生率以及更长的住院时间。PA组、PS组和SA组患者也出现了这些结果（所有比较p < 0.05）。SD组患者术后推注阿芬太尼的给药次数比PS组、PA组和SA组患者少（所有比较p < 0.05）。
虽然丙泊酚 - 七氟醚 - 阿芬太尼联合用药改善了气道条件，但它导致了全身性低血压和频繁的心动过缓。由于呼吸抑制作用，在自主呼吸方案中，不进行滴定的固定剂量阿芬太尼（10 µg/kg）可能不安全。
