Reinhart D J, Klein K W, Schroff E
Department of Anesthesiology, University of Utah, McKay-Dee Hospital, Ogden 84409-0370, USA.
Anesth Analg. 1994 Aug;79(2):281-4. doi: 10.1213/00000539-199408000-00013.
We evaluated the effect of transdermal scopolamine on the incidence of postoperative nausea and vertigo after outpatient ear surgery (exploratory tympanotomy, mastoidectomy, or endolymphatic sac and oval and round window surgery) in a double-blind, placebo-controlled study. A transdermal patch containing either scopolamine (n = 19) or placebo (n = 20) was placed behind the nonsurgical ear 2 h before surgery. Anesthesia was induced with thiopental (4-6 mg/kg intravenously [i.v.]), sufentanil (0.5 microgram/kg i.v.), and vecuronium (0.1 mg/kg i.v.) and maintained with isoflurane (0.2%-2%) and nitrous oxide (70%) in oxygen. Patients were observed postoperatively in the recovery room and after discharge for 72 h. There was no significant difference between groups with respect to time in recovery room, time to discharge, incidence of in-house nausea, vomiting, amount of antiemetics required, or postoperative visual analog scale (VAS) scores while in the hospital. After discharge, there were lower VAS nausea scores (by repeat measures analysis, P < 0.05) and a lower reported incidence of nausea (31% vs 62%; P < 0.05) and vertigo (6.2% vs 25%; P < 0.05) in the active patch group versus the placebo group. There was a higher incidence of dry mouth in the active patch group (44% vs 25%). Seven patients did not complete the study due to failure to keep the patch in place or failure to return the diary from home; and one patient from the placebo patch group was admitted for uncontrolled nausea and vomiting. The authors concluded that transdermal scopolamine is effective in reducing, but not eliminating, postoperative nausea and vertigo after discharge in outpatient ear surgery.
在一项双盲、安慰剂对照研究中，我们评估了透皮东莨菪碱对门诊耳部手术（探查性鼓室切开术、乳突切除术或内淋巴囊及椭圆窗和圆窗手术）后恶心和眩晕发生率的影响。术前2小时，在非手术耳后方贴敷含东莨菪碱（n = 19）或安慰剂（n = 20）的透皮贴剂。静脉注射硫喷妥钠（4 - 6 mg/kg）、舒芬太尼（0.5 μg/kg）和维库溴铵（0.1 mg/kg）诱导麻醉，并用异氟烷（0.2% - 2%）和氧化亚氮（70%）加氧气维持麻醉。术后在恢复室对患者进行观察，并在出院后观察72小时。两组在恢复室停留时间、出院时间、院内恶心和呕吐发生率、所需止吐药用量或住院期间术后视觉模拟评分（VAS）方面无显著差异。出院后，与安慰剂组相比，活性贴剂组的VAS恶心评分较低（通过重复测量分析，P < 0.05），报告的恶心发生率较低（31%对62%；P < 0.05），眩晕发生率也较低（6.2%对25%；P < 0.05）。活性贴剂组口干发生率较高（44%对25%）。7名患者因未能固定贴剂或未从家中返回日记而未完成研究；安慰剂贴剂组有1名患者因无法控制的恶心和呕吐入院。作者得出结论，透皮东莨菪碱在减少门诊耳部手术后出院后恶心和眩晕方面有效，但不能消除。
