基于氟烷、异氟烷和安氟醚麻醉后的呕吐、干呕、头痛及烦躁不安。一项耳鼻喉科及眼科手术后汇总数据的分析。

Vomiting, retching, headache and restlessness after halothane-, isoflurane- and enflurane-based anaesthesia. An analysis of pooled data following ear, nose, throat and eye surgery.

作者信息

van den Berg A A, Honjol N M, Mphanza T, Rozario C J, Joseph D

机构信息

Department of Anaesthesia, Riyadh Armed Forces Hospital, Kingdom of Saudi Arabia.

出版信息

Acta Anaesthesiol Scand. 1998 Jul;42(6):658-63. doi: 10.1111/j.1399-6576.1998.tb05298.x.

DOI:10.1111/j.1399-6576.1998.tb05298.x

PMID:9689271

Abstract

BACKGROUND

Isoflurane has exceeded halothane and enflurane in usage. A literature search, however, revealed no data comparing the effects on emesis, headache and restlessness of these three agents.

METHODS

With hospital ethics committee approval and patient consent, a prospective, randomised, double-blind study of 556 patients undergoing ENT and eye surgery was undertaken to evaluate the effects of halothane, isoflurane and enflurane on vomiting, retching, headache and restlessness until 24 h after anaesthesia. Balanced general anaesthesia was administered comprising benzodiazepine premedication, induction with thiopentone-atracurium-morphine (ENT patients) or fentanyl (eye patients), controlled ventilation and maintenance with either halothane 0.4-0.6 vol% (n = 186), isoflurane 0.6-0.8 vol% (n = 184) or enflurane 0.8-1 vol% (n = 186) in nitrous oxide 67% and oxygen.

RESULTS

The three study groups were comparable, and comprised comparable subgroups having ear, nose, throat, intraocular and non-intraocular surgery. During early recovery from anaesthesia, the respective requirements for halothane, isoflurane and enflurane for analgesia (7%, 9% and 10%), frequency of emesis (6%, 8% and 8%), antiemetic requirements (1%, 1% and 2%), restlessness-pain scores and time spent in the recovery ward (27 SD 10, 31 SD 12 and 26 SD 9 min) were similar. During the ensuing 24-h postoperative period, patients who had isoflurane experienced emesis less often than those who had halothane (36% vs 46%, P < 0.025) but did so with similar frequency to those who had enflurane (46% vs 41%). Antiemetic requirements were least in those given isoflurane (isoflurane 12%, halothane and enflurane 23% each, P < 0.005), but headache and analgesic requirements were similar.

CONCLUSION

Isoflurane induces less postoperative emesis than halothane, but headache is similarly frequent after anaesthesia with any of these agents.

摘要

背景

异氟烷的使用已超过氟烷和恩氟烷。然而，文献检索未发现比较这三种药物对呕吐、头痛和烦躁影响的数据。

方法

在获得医院伦理委员会批准并征得患者同意后，对556例接受耳鼻喉科和眼科手术的患者进行了一项前瞻性、随机、双盲研究，以评估氟烷、异氟烷和恩氟烷对麻醉后24小时内呕吐、干呕、头痛和烦躁的影响。采用平衡全身麻醉，包括苯二氮卓类药物术前用药，硫喷妥钠 - 阿曲库铵 - 吗啡（耳鼻喉科患者）或芬太尼（眼科患者）诱导，控制通气，并在67%氧化亚氮和氧气中分别用0.4 - 0.6体积%氟烷（n = 186）、0.6 - 0.8体积%异氟烷（n = 184）或0.8 - 1体积%恩氟烷（n = 186）维持麻醉。

结果

三个研究组具有可比性，并且包括进行耳、鼻、喉、眼内和非眼内手术的可比亚组。在麻醉早期恢复期间，氟烷、异氟烷和恩氟烷在镇痛方面的各自需求量（7%、9%和10%）、呕吐频率（6%、8%和8%）、止吐药需求量（1%、1%和2%）、烦躁 - 疼痛评分以及在恢复病房的停留时间（27±10、31±12和26±9分钟）相似。在随后的术后24小时内，使用异氟烷的患者呕吐发生率低于使用氟烷的患者（36%对46%，P < 0.025），但与使用恩氟烷的患者发生率相似（46%对41%）。使用异氟烷的患者止吐药需求量最少（异氟烷12%，氟烷和恩氟烷均为23%，P < 0.005），但头痛和镇痛需求量相似。