Nathanson M H, Fredman B, Smith I, White P F
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas 75235-9068, USA.
Anesth Analg. 1995 Dec;81(6):1186-90. doi: 10.1097/00000539-199512000-00012.
The recovery characteristics of desflurane and sevoflurane were compared when used for maintenance of ambulatory anesthesia. After obtaining informed consent, 42 healthy, unpremedicated women undergoing laparoscopic sterilization procedures were studied. Anesthesia was induced with propofol, 1.5-2.0 mg/kg, and maintained with either desflurane 3%-6% (n = 21) or sevoflurane 1%-2% (n = 21) with 60% nitrous oxide in oxygen. Intraoperative analgesia and neuromuscular block was achieved using fentanyl and vecuronium, respectively. The inhaled anesthetics were titrated to achieve an adequate clinical "depth of anesthesia" and to maintain mean arterial pressure (MAP) within 20% of the preinduction baseline values. Visual analog scales (VAS) and the digit-symbol substitution test (DSST) were performed preoperatively and at 30-min intervals during the recovery period. There were no differences between the two groups in the total doses of propofol, fentanyl, or vecuronium. Heart rate (HR) values were lower in the sevoflurane group during the induction-to-incision period. However, HR and MAP were otherwise similar during the maintenance and recovery periods. Use of desflurane led to a more rapid emergence (4.8 +/- 2.4 vs 7.8 +/- 3.8 min) and shorter time to extubation (5.1 +/- 2.2 vs 8.2 +/- 4.2 min) compared to sevoflurane (mean values +/- SD). Intermediate recovery times, postoperative VAS and DSST scores, and side effects were similar in the two treatment groups. Although sevoflurane was associated with a slower emergence from anesthesia than desflurane after laparoscopic surgery, recovery of cognitive function and discharge times were similar in the two anesthetic groups. Thus, it would appear that sevoflurane is an acceptable alternative to desflurane for maintenance of outpatient anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)
比较地氟烷和七氟烷用于门诊麻醉维持时的恢复特征。在获得知情同意后，对42例接受腹腔镜绝育手术的健康、未用术前药的女性进行了研究。用1.5 - 2.0mg/kg丙泊酚诱导麻醉，并用3% - 6%地氟烷（n = 21）或1% - 2%七氟烷（n = 21）加60%氧化亚氮和氧气维持麻醉。分别使用芬太尼和维库溴铵实现术中镇痛和神经肌肉阻滞。吸入麻醉药进行滴定以达到适当的临床“麻醉深度”，并将平均动脉压（MAP）维持在诱导前基线值的20%以内。术前以及恢复期间每隔30分钟进行视觉模拟评分（VAS）和数字符号替换测试（DSST）。两组间丙泊酚、芬太尼或维库溴铵的总剂量无差异。七氟烷组在诱导至切口期心率（HR）值较低。然而，在维持和恢复期间HR和MAP在其他方面相似。与七氟烷相比，使用地氟烷导致苏醒更快（4.8±2.4对7.8±3.8分钟）和拔管时间更短（5.1±2.2对8.2±4.2分钟）（平均值±标准差）。两个治疗组的中期恢复时间、术后VAS和DSST评分以及副作用相似。虽然腹腔镜手术后七氟烷的麻醉苏醒比地氟烷慢，但两个麻醉组的认知功能恢复和出院时间相似。因此，对于门诊麻醉的维持，七氟烷似乎是地氟烷的可接受替代药物。（摘要截短至250字）
