Song D, Joshi G P, White P F
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 75235-9068, USA.
Anesth Analg. 1998 Feb;86(2):267-73. doi: 10.1097/00000539-199802000-00009.
This study was designed to test the hypothesis that using the less soluble volatile anesthetics, desflurane and sevoflurane, as alternatives to propofol for maintenance of anesthesia facilitates the ability of outpatients to achieve postanesthesia care unit (PACU) discharge criteria (i.e., fast-track eligibility) on arrival in the PACU after laparoscopic surgery. One hundred-twenty consenting women undergoing laparoscopic tubal ligation procedures were randomly assigned to one of three treatment groups. After a standardized induction of anesthesia and tracheal intubation sequence, anesthesia was maintained with either desflurane 2%-6%, sevoflurane 0.6%-1.75%, or propofol 50-150 microg x kg(-1) x min(-1) in combination with nitrous oxide 60% in oxygen. Recovery times, postanesthesia recovery scores, and the number and type of therapeutic interventions in the PACU were recorded. Compared with the propofol group, the times to awakening and to achieve a recovery score of 10 were significantly shorter, and the percentage of patients judged fast-track eligible on arrival in the PACU was significantly higher, in the desflurane and sevoflurane groups (90% and 75% vs 26%). In conclusion, compared with propofol, the use of desflurane and sevoflurane for the maintenance of general anesthesia resulted in a higher percentage of patients being judged fast-track eligible after outpatient laparoscopic tubal ligation procedures.
Bypassing the recovery room by transferring outpatients directly to the step-down unit after ambulatory surgery ("fast-tracking") could result in significant cost-savings. We examined the effects of three different maintenance anesthetics--desflurane, sevoflurane, and propofol--on the fast-track eligibility of outpatients after laparoscopic tubal ligation surgery. Compared with propofol, desflurane and sevoflurane resulted in a higher percentage of outpatients being judged eligible for fast-tracking.
本研究旨在验证以下假设：使用溶解度较低的挥发性麻醉剂地氟烷和七氟烷替代丙泊酚维持麻醉，有助于门诊患者在腹腔镜手术后进入麻醉后护理单元（PACU）时达到PACU出院标准（即符合快速康复条件）。120名同意接受腹腔镜输卵管结扎手术的女性被随机分配到三个治疗组之一。在进行标准化的麻醉诱导和气管插管后，分别用2%-6%的地氟烷、0.6%-1.75%的七氟烷或50-150μg·kg⁻¹·min⁻¹的丙泊酚联合60%氧化亚氮和氧气维持麻醉。记录恢复时间、麻醉后恢复评分以及PACU中的治疗干预次数和类型。与丙泊酚组相比，地氟烷组和七氟烷组的苏醒时间和恢复评分达到10分的时间显著缩短，到达PACU时被判定符合快速康复条件的患者百分比显著更高（分别为90%和75%，而丙泊酚组为26%）。总之，与丙泊酚相比，使用地氟烷和七氟烷维持全身麻醉后，门诊腹腔镜输卵管结扎手术后被判定符合快速康复条件的患者百分比更高。
门诊手术（“快速康复”）后直接将门诊患者转至降级护理单元而不经过恢复室可显著节省成本。我们研究了三种不同的维持麻醉剂——地氟烷、七氟烷和丙泊酚——对腹腔镜输卵管结扎手术后门诊患者快速康复条件的影响。与丙泊酚相比，地氟烷和七氟烷使被判定符合快速康复条件的门诊患者百分比更高。
