Patel N, Smith C E, Pinchak A C, Sidhu T, Morscher A, Podugu R R, Hagen J F
Department of Anesthesiology, MetroHealth Medical Center, Cleveland, Ohio 44109, USA.
J Clin Anesth. 1996 Mar;8(2):130-5. doi: 10.1016/0952-8180(95)00197-2.
To determine the influence of anesthetic technique and primary drug on operating room (OR) exit time (time between end of surgery until time patient exists the OR) after addition of desflurane to the hospital formulary.
Prospective study.
Ambulatory surgery unit of a university hospital.
1,568 outpatients requiring anesthesia.
Addition of desflurane to the hospital formulary, and substitution of desflurane vaporizers for enflurane vaporizers in the ambulatory surgery unit.
The following information was recorded for all anesthetic encounters over a six-month time interval: demographics, duration of surgery, primary anesthetic technique, primary anesthetic drug, and exit times. General anesthesia was used in 907 patients [desflurane: 209 patients, isoflurane: 429 patients, halothane: 192 patients, propofol: 72 patients, other intravenous (i.v.): 5 patients], major conduction anesthesia (spinal and epidural) in 43 patients, peripheral nerve blocks in 90 patients, and i.v. sedation in 528 patients. The exit time was significantly greater ( < 0.05) in patients who received general anesthesia (mean +/- SEM 14 +/- 0.2 min) compared with spinal/epidural (8 +/- 0.7 min), nerve blocks (8 +/- 0.4 min) and i.v. sedation (7 +/- 0.2 min). Exit times were longer in older patients receiving general anesthesia (exit time = 12.3 + 0.04 x age, SE = 6.7 min, p < 0.0009), whereas exit times were shorter in older individuals receiving i.v. sedation (exit time = 8.97 - 0.038 x age, SE = 3.6 min, p < 0.0001). For patients receiving i.v. sedation, exit times were shorter as duration of surgery increased (exit time = 7.86 - 0.015 x duration of surgery, SE = 3.6 min, p < 0.0002). Primary anesthetic drug did not affect exit times.
Regional anesthesia and i.v. sedation were associated with faster OR exit times compared with general anesthesia. Despite desflurane's shorter elimination kinetics and recovery characteristics, use of this drug did not result in shorter exit times.
确定在医院药品目录中添加地氟烷后，麻醉技术和主要药物对手术室（OR）出院时间（手术结束至患者离开手术室的时间）的影响。
前瞻性研究。
大学医院的门诊手术科室。
1568例需要麻醉的门诊患者。
在医院药品目录中添加地氟烷，并在门诊手术科室用地氟烷蒸发器替代恩氟烷蒸发器。
在六个月的时间间隔内，记录了所有麻醉过程的以下信息：人口统计学资料、手术持续时间、主要麻醉技术、主要麻醉药物和出院时间。907例患者采用全身麻醉[地氟烷：209例患者，异氟烷：429例患者，氟烷：192例患者，丙泊酚：72例患者，其他静脉注射（i.v.）：5例患者]，43例患者采用主要传导麻醉（脊髓和硬膜外麻醉），90例患者采用周围神经阻滞，528例患者采用静脉镇静。与脊髓/硬膜外麻醉（8±0.7分钟）、神经阻滞（8±0.4分钟）和静脉镇静（7±0.2分钟）相比，接受全身麻醉的患者出院时间明显更长（<0.05）（平均±标准误14±0.2分钟）。接受全身麻醉的老年患者出院时间更长（出院时间=12.3 + 0.04×年龄，标准误=6.7分钟，p<0.0009），而接受静脉镇静的老年个体出院时间更短（出院时间=8.97 - 0.038×年龄，标准误=3.6分钟，p<0.0001）。对于接受静脉镇静的患者，出院时间随着手术持续时间的增加而缩短（出院时间=7.86 - 0.015×手术持续时间，标准误=3.6分钟，p<0.0002）。主要麻醉药物不影响出院时间。
与全身麻醉相比，区域麻醉和静脉镇静与更快的手术室出院时间相关。尽管地氟烷的消除动力学和恢复特征较短，但使用该药物并未导致出院时间缩短。
