Blobner M, Schneck H J, Felber A R, Goegler S, Feussner H, Jelen-Esselborn S
Institut für Anaesthesiologie, Technischen Universität München.
Anaesthesist. 1994 Sep;43(9):573-81. doi: 10.1007/s001010050095.
Total intravenous anaesthesia (TIVA) is increasingly used in short-stay surgery such as laparoscopic cholecystectomy. TIVA may provide fast recovery of psychomotor function, thus being of benefit to both the patient's behaviour and postoperative management. The purpose of this prospective study was to compare postoperative recovery from TIVA using propofol or methohexitone as the hypnotic component and balanced anaesthesia with isoflurane. PATIENTS AND METHODS. After giving informed consent and approval by the ethical committee of our hospital, 51 patients (ASA I, II) were investigated in a prospective study. Patients were randomised to receive either isoflurane, methohexitone, or propofol. Perioperative management with regard to premedication, intraoperative analgesia, relaxation, ventilation, and postoperative analgesia was carried out identically for all groups. Postoperative vigilance, pain, and nausea scores were assessed 15, 30, 60, 120, and 360 min after extubation with a visual analogue scale (VAS). At the same points, psychomotor recovery was investigated with the following assays: sedation as shown in Table 1; orientation with ten questions as to person, time, and location; memory as expressed by the patient's ability to repeat five words; a calculation test with five subtractions of the number 7 beginning from 100; and word generation by the number of words with an initial "m" given within 1 min and with animal names. Data were analysed with Kruskal Wallis' test for multiple comparisons between the groups and with Friedman's test for repeated measurements. All values are given as medians (interquartile range) or ranges. RESULTS. There was no difference between the groups' physical condition (Table 2). All intraoperative parameters compared well between groups; the management of anaesthesia was smoother with isoflurane than with the other anaesthetics. Psychomotor recovery was somewhat faster in the propofol group than the methohexitone group, as indicated by sedation score, orientation, memory and calculation tests (Table 4), word generation tests (Fig. 4), and subjective vigilance score (Fig. 3). The difference in recovery time between the propofol and isoflurane groups was minimal and without any significance or relevance. The incidence of postoperative nausea was significantly lower after balanced anaesthesia with isoflurane (24%, P < 0.05) as compared to TIVA with either propofol (53%) or methohexitone (41%). However, there were only minor differences between the groups; the ability to cooperate and be mobilised was not limited. DISCUSSION. Each of the three techniques used in this study is suitable for anaesthesia in patients undergoing laparoscopic cholecystectomy. Since fast recovery of vigilance and psychomotor function is very important in outpatient surgery, opioid-supplemented propofol anaesthesia is well established. Inhalation anaesthesia with isoflurane in air/oxygen without adding nitrous oxide compares well to propofol TIVA for laparoscopic surgery.
全静脉麻醉（TIVA）越来越多地用于诸如腹腔镜胆囊切除术等短时间手术中。全静脉麻醉可能使精神运动功能快速恢复，因此对患者的行为和术后管理均有益处。这项前瞻性研究的目的是比较使用丙泊酚或甲己炔巴比妥作为催眠成分的全静脉麻醉与异氟烷平衡麻醉后的术后恢复情况。患者与方法。在获得我院伦理委员会批准并取得知情同意后，对51例（ASA I、II级）患者进行了一项前瞻性研究。患者被随机分为接受异氟烷、甲己炔巴比妥或丙泊酚组。所有组在术前用药、术中镇痛、肌肉松弛、通气及术后镇痛等围手术期管理方面均相同。拔管后15、30、60、120和360分钟，使用视觉模拟量表（VAS）评估术后警觉性、疼痛和恶心评分。在相同时间点，通过以下测定方法研究精神运动恢复情况：镇静情况（如表1所示）；通过询问关于人物、时间和地点的10个问题来评估定向力；通过患者重复5个单词的能力来评估记忆力；从100开始连续减去5次数字7的计算测试；以及在1分钟内说出以字母“m”开头的单词数量和动物名称的单词生成测试。数据采用Kruskal Wallis检验进行组间多重比较，采用Friedman检验进行重复测量分析。所有数值均以中位数（四分位间距）或范围表示。结果。各组患者身体状况无差异（表2）。各组间所有术中参数比较良好；异氟烷麻醉的管理比其他麻醉方法更平稳。丙泊酚组的精神运动恢复比甲己炔巴比妥组稍快，这在镇静评分、定向力、记忆力和计算测试（表4）、单词生成测试（图4）及主观警觉性评分（图3）中均有体现。丙泊酚组和异氟烷组恢复时间的差异极小，无任何显著意义或相关性。与丙泊酚（53%）或甲己炔巴比妥（41%）的全静脉麻醉相比，异氟烷平衡麻醉后术后恶心的发生率显著较低（24%，P<0.05）。然而，各组间差异仅较小；合作及活动能力未受限制。讨论。本研究中使用的三种技术均适用于接受腹腔镜胆囊切除术患者的麻醉。由于在门诊手术中快速恢复警觉性和精神运动功能非常重要，补充阿片类药物的丙泊酚麻醉已得到广泛认可。在空气/氧气中使用异氟烷进行吸入麻醉且不添加氧化亚氮，与丙泊酚全静脉麻醉用于腹腔镜手术相比效果良好。
