Ved S A, Walden T L, Montana J, Lea D E, Tefft M C, Kataria B K, Pudimat M A, Nicodemus H F, Milmoe G J
Department of Anesthesia, Georgetown University Medical Center, Washington, D.C. 20007-2197, USA.
Anesthesiology. 1996 Jul;85(1):4-10. doi: 10.1097/00000542-199607000-00002.
The authors' purpose in this study was to compare prospectively four different anesthetic induction and maintenance techniques using nitrous oxide with halothane and/or propofol for vomiting and recovery after outpatient tonsillectomy and adenoidectomy procedures in children.
Eighty unpremedicated children, aged 3-10 yr, were assigned randomly to four groups: group H/H, 0.5-2% halothane induction/halothane maintenance; group P/P, 3-5 mg.kg-1 propofol induction and 0.1-0.3 mg.kg-1.min-1 propofol maintenance; group H/P, 0.1-0.3 mg.kg-1.min-1 halothane induction/propofol maintenance; and group P/H, 3-5 mg.kg-1 propofol induction and 0.5-2% halothane maintenance. Nitrous oxide (67%) and oxygen (33%) were administered in all the groups. Other treatments and procedures were standardized intra- and postoperatively. Results of postoperative vomiting and recovery were analyzed in the first 6 h and beyond 6 h.
Logistic regression showed that vomiting occurred 3.5 times as often when halothane was used for maintenance of anesthesia (groups H/H and P/H) compared with the use of propofol (groups P/P and H/P; Odds Ratio 3.5; 95% confidence interval 1.3 and 9.4, respectively; P = 0.012). A significant association between vomiting ( < 6 h: yes/no) and discharge times ( > 6 h: yes/no) (Odd's Ratio = 3.6; 95% confidence interval: 1.02, 12.4, respectively) (P = 0.046) was shown. However, no significant differences among the groups in the incidence of vomiting beyond 6 h, recurrent vomiting, or hospital discharge times were shown.
After tonsillectomy and adenoidectomy procedures, despite reduced postoperative vomiting with use of propofol rather than halothane, along with nitrous oxide for anesthetic maintenance, the authors found no differences in "true" endpoints such as unplanned admissions or discharge times. Among the groups, the main factor that delayed hospital discharge beyond 6 h was vomiting within the first 6 h.
本研究中作者的目的是前瞻性地比较四种不同的麻醉诱导和维持技术，这些技术使用氧化亚氮联合氟烷和/或丙泊酚，用于儿童门诊扁桃体切除术和腺样体切除术术后的呕吐及恢复情况。
80名未用术前药的3至10岁儿童被随机分为四组：H/H组，0.5 - 2%氟烷诱导/氟烷维持；P/P组，3 - 5mg·kg⁻¹丙泊酚诱导及0.1 - 0.3mg·kg⁻¹·min⁻¹丙泊酚维持；H/P组，0.1 - 0.3mg·kg⁻¹·min⁻¹氟烷诱导/丙泊酚维持；P/H组，3 - 5mg·kg⁻¹丙泊酚诱导及0.5 - 2%氟烷维持。所有组均给予氧化亚氮（67%）和氧气（33%）。术中和术后其他治疗及操作均标准化。分析术后6小时内及6小时后的呕吐及恢复结果。
逻辑回归显示，与使用丙泊酚（P/P组和H/P组）相比，使用氟烷维持麻醉（H/H组和P/H组）时呕吐发生频率高3.5倍（优势比3.5；95%置信区间分别为1.3和9.4；P = 0.012）。显示呕吐（<6小时：是/否）与出院时间（>6小时：是/否）之间存在显著关联（优势比 = 3.6；95%置信区间分别为1.02、12.4）（P = 0.046）。然而，6小时后呕吐发生率、反复呕吐或出院时间在各组之间未显示出显著差异。
扁桃体切除术和腺样体切除术后，尽管使用丙泊酚而非氟烷并联合氧化亚氮维持麻醉可减少术后呕吐，但作者发现诸如非计划入院或出院时间等“真正”终点并无差异。在各组中，导致6小时后延迟出院的主要因素是最初6小时内的呕吐。
