Davis P J, Cohen I T, McGowan F X, Latta K
Department of Anesthesiology, Children's Hospital of Pittsburgh, Pennsylvania 15213-2583.
Anesthesiology. 1994 Feb;80(2):298-302. doi: 10.1097/00000542-199402000-00009.
Desflurane is a new potent, inhaled anesthetic agent with low blood-gas solubility that should allow for the rapid induction of and emergence from anesthesia. However, its extreme pungency makes desflurane unacceptable for induction of anesthesia in children. This study was undertaken to determine the airway properties of desflurane administered by mask after anesthetic induction with halothane and nitrous oxide, and to compare the emergence and recovery properties of minimum alveolar concentration (MAC)-equivalent concentrations of desflurane or halothane in nitrous oxide in pediatric patients undergoing ambulatory surgery.
Forty-five children undergoing ambulatory surgery for inguinal hernia repair, orchiopexy, and/or circumcision were randomized into two groups. Both groups were premedicated with intranasal midazolam and given halothane and nitrous oxide by mask to induce anesthesia. A caudal block was placed in children in both groups after anesthetic induction. For maintenance of anesthesia, group I patients (n = 22) were switched over to desflurane (1 MAC) and nitrous oxide, and group II patients (n = 23) continued to receive halothane (1 MAC) and nitrous oxide. All patients breathed spontaneously throughout the entire procedure, and all anesthetics were terminated abruptly at the conclusion of surgery. Recovery indicators (time to first response, length of time in the recovery room and length of time in the hospital) and the quality of the anesthetic emergence were assessed by a nurse blinded to each patient's anesthetic. This observer was present with the patient throughout his or her ambulatory hospitalization and continuously assessed the recovery indicators according to preset criteria.
The groups did not differ with respect to age, weight, or dose of midazolam. Although group I (desflurane) had a longer anesthesia time (52 +/- 12 min vs. 42 +/- 10 min), their time to first response (9.5 +/- 6.8 min vs. 20.9 +/- 14.7 min) and their recovery room time (21 +/- 10.7 min vs. 29 +/- 14.6 min) were less than those in group II (halothane). There was a trend for patient emergence from desflurane anesthesia to be associated with a higher incidence of emergence delirium (50% vs. 21%). The two groups were similar with respect to overall duration of postoperative ambulatory hospitalization.
In children premedicated with intranasal midazolam, desflurane maintenance anesthesia allows for a faster recovery. However, depending on the institution's criteria for ambulatory surgical patient discharge, desflurane may or may not affect the overall hospitalization time.
地氟烷是一种新型强效吸入麻醉剂，血液-气体溶解度低，应能实现麻醉的快速诱导和苏醒。然而，其极强的刺激性使得地氟烷不适合用于小儿麻醉诱导。本研究旨在确定在氟烷和氧化亚氮诱导麻醉后通过面罩给予地氟烷的气道特性，并比较接受门诊手术的小儿患者中，与最低肺泡浓度（MAC）等效的地氟烷或氟烷在氧化亚氮中的苏醒和恢复特性。
45例接受腹股沟疝修补术、睾丸固定术和/或包皮环切术门诊手术的儿童被随机分为两组。两组均预先经鼻给予咪达唑仑，并通过面罩给予氟烷和氧化亚氮诱导麻醉。麻醉诱导后，两组儿童均行骶管阻滞。麻醉维持时，I组患者（n = 22）改用1 MAC地氟烷和氧化亚氮，II组患者（n = 23）继续接受1 MAC氟烷和氧化亚氮。所有患者在整个手术过程中均自主呼吸，手术结束时所有麻醉药均突然停用。由对每位患者麻醉情况不知情的护士评估恢复指标（首次反应时间、恢复室停留时间和住院时间）以及麻醉苏醒质量。该观察者在患者整个门诊住院期间一直陪伴，并根据预设标准持续评估恢复指标。
两组在年龄、体重或咪达唑仑剂量方面无差异。尽管I组（地氟烷组）麻醉时间较长（52±12分钟 vs. 42±10分钟），但其首次反应时间（9.5±6.
