Jellish W S, Leonetti J P, Murdoch J R, Fowles S
Department of Anesthesiology, Loyola University Medical Center, Maywood, IL 60153, USA.
J Clin Anesth. 1995 Jun;7(4):292-6. doi: 10.1016/0952-8180(95)00030-l.
To determine if a total intravenous (i.v.) technique with propofol and fentanyl is superior to isoflurane anesthesia in patients undergoing middle ear surgery.
Prospective, randomized study.
Inpatient otolaryngology service at a university medical center.
102 ASA status I and II nonobese patients with no significant history of diabetes, chronic cholecystitis, neuropathy, or neuromuscular disorders that could produce delayed gastric emptying.
Patients were admitted to the study and randomly divided into three equal groups. I.V. administration of thiopental sodium 5 mg/kg for induction of anesthesia followed by 60% air/oxygen (O2) with isoflurane 1% to 2% end-tidal for maintenance anesthesia (group 1). The same anesthetic was given as above, with the addition of droperidol 25 mcg/kg given after induction (group 2). I.V. administration of propofol 2 mg/kg for induction of anesthesia followed by propofol 50 to 250 mcg/kg/min for maintenance anesthesia. All groups received fentanyl 3 mcg/kg i.v. after induction.
Surgical duration, induction, maintenance, and total anesthesia times were recorded in addition to eye opening and extubation. Intergroup comparisons of postoperative nausea, vomiting, and pain were done, as were recovery scores using the Steward system. Patients receiving propofol had significantly less nausea than those receiving isoflurane only (4 of 34 versus 12 of 34, p < 0.05) as well as vomiting (2 of 34 versus 8 of 34, p < 0.05). Immediate recovery scores were significantly better for propofol compared with the isoflurane/droperidol group. Recovery at 30 minutes was also faster with propofol compared with isoflurane or isoflurane/droperidol (5.7 +/- 0.1 min versus 5.1 +/- 0.2 min and 5.2 +/- 0.2 min, p < 0.05).
Propofol-fentanyl seems to be a better anesthetic than isoflurane-fentanyl in reducing the incidence of nausea and vomiting after middle ear surgery. Through the addition of droperidol to the isoflurane anesthetic seemed as effective, emergence from anesthesia was slower. For middle ear surgeries producing emesis, propofol-based anesthetics produced a rapid emergence with less nausea and vomiting.
确定在中耳手术患者中，丙泊酚和芬太尼的全静脉技术是否优于异氟烷麻醉。
前瞻性随机研究。
一所大学医学中心的住院耳鼻喉科。
102例ASA分级为I级和II级的非肥胖患者，无糖尿病、慢性胆囊炎、神经病变或神经肌肉疾病等可能导致胃排空延迟的重大病史。
患者纳入研究并随机分为三组。静脉注射硫喷妥钠5mg/kg诱导麻醉，随后用60%空气/氧气（O2）加1%至2%呼气末异氟烷维持麻醉（第1组）。给予与上述相同的麻醉剂，诱导后加用氟哌利多25mcg/kg（第2组）。静脉注射丙泊酚2mg/kg诱导麻醉，随后以丙泊酚50至250mcg/kg/min维持麻醉。所有组诱导后静脉注射芬太尼3mcg/kg。
记录手术时长、诱导、维持及总麻醉时间，以及睁眼和拔管情况。对术后恶心、呕吐和疼痛进行组间比较，并使用Steward系统进行恢复评分。接受丙泊酚的患者恶心发生率显著低于仅接受异氟烷的患者（34例中的4例对34例中的12例，p<0.05），呕吐发生率也较低（34例中的2例对34例中的8例，p<0.05）。与异氟烷/氟哌利多组相比，丙泊酚组的即刻恢复评分显著更好。丙泊酚组30分钟时的恢复也比异氟烷组或异氟烷/氟哌利多组更快（5.7±0.1分钟对5.1±0.2分钟和5.2±0.2分钟，p<0.05）。
在降低中耳手术后恶心和呕吐发生率方面，丙泊酚-芬太尼似乎比异氟烷-芬太尼是更好的麻醉剂。虽然在异氟烷麻醉中加用氟哌利多似乎同样有效，但麻醉苏醒较慢。对于引起呕吐的中耳手术，丙泊酚类麻醉剂可使患者快速苏醒，且恶心和呕吐较少。
