Sukhani R, Lurie J, Jabamoni R
Department of Anesthesiology, Loyola University Medical Center, Maywood, Illinois 60153.
Anesth Analg. 1994 May;78(5):831-5. doi: 10.1213/00000539-199405000-00002.
The role of nitrous oxide in postoperative emesis is controversial. This prospective randomized study was performed to compare the emetic sequelae and quality of recovery between a group of patients anesthetized with propofol alone and a group anesthetized with propofol plus nitrous oxide. Seventy patients, ASA grade I or II, scheduled for ambulatory gynecologic laparoscopy under general anesthesia were included. Most factors which could influence the incidence of postoperative emesis were controlled. The overall incidence of emetic sequelae during the first 24 h postoperatively was 25% in the group anesthetized with propofol alone versus 29% for the group anesthetized with propofol and nitrous oxide. The incidence of emetic sequelae requiring therapeutic intervention was 13% and 6%, respectively. This difference was not statistically significant. The group of patients who received propofol alone required an average propofol dose of 221.5 +/- 71.9 micrograms.kg-1.min-1 to maintain anesthesia compared with 162.5 +/- 43.9 micrograms.kg-1.min-1 for the group receiving propofol plus nitrous oxide (P < 0.001). The time from discontinuation of propofol to eye-opening and orientation was significantly longer in patients anesthetized with propofol alone. Otherwise, the recovery variables were comparable between the two groups. We conclude that supplementing propofol with nitrous oxide in patients undergoing ambulatory laparoscopy reduces the requirements of propofol, expedites immediate recovery (emergence), and does not increase the incidence of postoperative emesis. This tends to confirm that there is no clinical advantage to omitting nitrous oxide.
氧化亚氮在术后呕吐中的作用存在争议。本前瞻性随机研究旨在比较单纯使用丙泊酚麻醉的患者组与丙泊酚加氧化亚氮麻醉的患者组之间的呕吐后遗症及恢复质量。纳入了70例ASA I或II级、计划在全身麻醉下行门诊妇科腹腔镜手术的患者。大多数可能影响术后呕吐发生率的因素得到了控制。术后24小时内，单纯丙泊酚麻醉组呕吐后遗症的总体发生率为25%，丙泊酚加氧化亚氮麻醉组为29%。需要治疗干预的呕吐后遗症发生率分别为13%和6%。这一差异无统计学意义。单纯接受丙泊酚的患者组维持麻醉平均需要丙泊酚剂量为221.5±71.9微克·千克⁻¹·分钟⁻¹，而接受丙泊酚加氧化亚氮的患者组为162.5±43.9微克·千克⁻¹·分钟⁻¹（P<0.001）。单纯丙泊酚麻醉的患者从停用丙泊酚到睁眼和定向的时间明显更长。否则，两组之间的恢复变量具有可比性。我们得出结论，在接受门诊腹腔镜手术的患者中，丙泊酚加用氧化亚氮可降低丙泊酚的需求量，加快即刻恢复（苏醒），且不增加术后呕吐的发生率。这倾向于证实不使用氧化亚氮并无临床优势。
