Nishimori M, Takasaki M, Akune T, Hanaoka K
Department of Anesthesiology, Tokyo Senbai Hospital.
Masui. 1998 Feb;47(2):168-73.
Laryngomicrosurgery has some special characteristics. It is under much stress such as intubation and direct laryngoscopy during a short operation time. Therefore both adequate anesthesia and quick recovery are needed. Thirty three ASA physical status I patients for laryngomicrosurgery were randomly assigned to receive either anesthesia with propofol and small dose of fentanyl (Group P) or anesthesia with thiopental and sevoflurane (Group S). Group P was induced with propofol 2-3 mg.kg-1 and fentanyl 0.1 mg and maintained with propofol 6 mg.kg-1.h-1 (from 10 mg.kg-1.h-1 by 2 mg.kg-1.h-1 decrement in interval of 10 minutes). No intravenous analgesic was added. Group S was induced with thiopental 4 -5 mg.kg-1 and maintained with sevoflurane 2-3%. We compared emergence time and the state of recovery 5 minutes after extubation and 5 minutes after entering the recovery room. There was no episode of inadequate anesthetic state in both groups. The emergence time was significantly shorter in Group P than in Group S. The state of recovery was much better in Group P compared with Group S in both 5 minutes after extubation and 5 minutes after entering the recovery room. Therefore, anesthesia with propofol and small dose of fentanyl at induction is more adequate compared with anesthesia with sevoflurane in laryngomicrosurgery.
支撑喉镜显微手术有一些特殊的特点。在短时间手术过程中，它面临诸如插管和直接喉镜检查等诸多压力。因此，既需要充分的麻醉，又需要快速恢复。33例拟行支撑喉镜显微手术的ASAⅠ级患者被随机分为两组，分别接受丙泊酚复合小剂量芬太尼麻醉（P组）或硫喷妥钠复合七氟醚麻醉（S组）。P组诱导时静脉注射丙泊酚2～3mg·kg-1和芬太尼0.1mg，维持用丙泊酚6mg·kg-1·h-1（从10mg·kg-1·h-1开始，每隔10分钟递减2mg·kg-1·h-1），不追加静脉镇痛药物。S组诱导时静脉注射硫喷妥钠4～5mg·kg-1，维持用2%～3%的七氟醚。比较两组患者的苏醒时间、拔管后5分钟及进入恢复室后5分钟的恢复情况。两组均未出现麻醉效果不佳的情况。P组的苏醒时间明显短于S组。在拔管后5分钟及进入恢复室后5分钟，P组的恢复情况均明显好于S组。因此，在支撑喉镜显微手术中，诱导时采用丙泊酚复合小剂量芬太尼麻醉比七氟醚麻醉更合适。
