Lebenbom-Mansour M H, Pandit S K, Kothary S P, Randel G I, Levy L
University of Michigan School of Medicine, Department of Anesthesiology, Ann Arbor.
Anesth Analg. 1993 May;76(5):936-41. doi: 10.1213/00000539-199305000-00004.
This study compares the induction, hemodynamic, and recovery characteristics of a general anesthetic with desflurane to one with propofol. Sixty outpatients presenting for orthopedic surgery received either a propofol induction of anesthesia followed by desflurane and nitrous oxide (Group 1), a propofol induction followed by propofol infusion and nitrous oxide (Group 2), a desflurane and nitrous oxide induction and maintenance (Group 3), or a desflurane induction and maintenance (Group 4). The quality of induction was inferior in Groups 3 and 4 with more breath-holding and excitation than in Groups 1 and 2. However, there was a more rapid emergence in Group 4 patients than any of the other groups. Group 4 patients were able to say their names (5.6 +/- 2.0 min vs 10.3 +/- 3.3 min, 8.6 +/- 3.1 min, and 9.3 +/- 1.5 min for Groups 1, 2, and 3, respectively) sooner after the discontinuation of anesthesia. Nonetheless, intermediate recovery was similar in Groups 2 and 4 being numerically but not statistically more rapid than in Groups 1 and 3. This pattern of intermediate recovery was also demonstrated by psychomotor function test results. Although there was no difference between the groups in postoperative narcotic requirement, more patients in Group 3 vomited (50%) than in either Group 2 (0%) or Group 4 (12.5%). Hemodynamically, the anesthetics were very similar. Although desflurane was a difficult drug to use for induction of anesthesia, this study demonstrates that desflurane is a suitable maintenance anesthetic for ambulatory surgery because it provides a rapid awakening and an intermediate recovery similar to propofol.
本研究比较了地氟烷与丙泊酚这两种全身麻醉药的诱导、血流动力学及恢复特征。60例接受骨科手术的门诊患者被分为四组：第一组先接受丙泊酚诱导麻醉，随后使用地氟烷和氧化亚氮；第二组先接受丙泊酚诱导，随后输注丙泊酚并使用氧化亚氮；第三组采用地氟烷和氧化亚氮诱导并维持麻醉；第四组采用地氟烷诱导并维持麻醉。与第一组和第二组相比，第三组和第四组的诱导质量较差，屏气和兴奋现象更多。然而，第四组患者的苏醒比其他任何一组都更快。麻醉停止后，第四组患者能更快说出自己的名字（分别为5.6±2.0分钟，而第一组、第二组和第三组分别为10.3±3.3分钟、8.6±3.1分钟和9.3±1.5分钟）。尽管如此，第二组和第四组的中期恢复情况相似，从数值上看比第一组和第三组更快，但无统计学差异。这种中期恢复模式也在精神运动功能测试结果中得到体现。虽然各组术后对麻醉性镇痛药的需求无差异，但第三组呕吐的患者（50%）比第二组（0%）或第四组（12.5%）更多。在血流动力学方面，这些麻醉药非常相似。尽管地氟烷用于麻醉诱导较困难，但本研究表明，地氟烷是门诊手术合适的维持麻醉药，因为它能提供与丙泊酚相似的快速苏醒和中期恢复。
