Cheng K I, Tang C S, Chu K S, Chen T I, Wang C J, Lee Z F, Tseng C K
Department of Anesthesiology, Kaohsiung Medical College, Taiwan.
J Formos Med Assoc. 1998 Aug;97(8):557-63.
Total intravenous anesthesia has recently become available for ambulatory surgery. It has the advantages of decreased air contamination from volatile anesthetics and decreased exposure of operating room personnel to volatile anesthetics. The purpose of this study was to compare the anesthetic properties of propofol/ketamine (total intravenous) anesthesia and thiopentone/halothane (intravenous and gaseous) anesthesia for herniorrhaphy or hydrocelectomy in children. Sixty children aged 2 to 7 years scheduled for herniorrhaphy or hydrocelectomy were allocated to two groups. The propofol/ketamine group (group 1) received a loading dose of intravenous propofol 3 mg/kg followed by propofol infusion 200 micrograms/kg/minute; additional bolus doses of propofol 1 mg/kg were given as needed or the infusion dose was increased or decreased by 33 micrograms/kg/minute as needed. Ketamine 1 mg/kg was administered intravenously 2 to 3 minutes before herniorrhaphy or hydrocelectomy to reinforce the analgesic and anesthetic effects of propofol. The thiopentone/halothane group (group 2) received intravenous thiopentone 6 mg/kg followed by halothane with 40% oxygen using a mask. Group 2 patients maintained spontaneous breathing with intermittent assistance and group 1 patients maintained spontaneous natural airway breathing during anesthesia. The scores on the postoperative assessment scale were higher in group 2 patients, indicating poorer anesthesia recovery characteristics, but the differences were not significant. Pain on injection was more frequent in group 1 (12/32) than in group 2 (2/28). The incidence of vomiting in group 2 (6/28) was significantly higher than in group 1 (0/32). We conclude that propofol/ketamine allows patients to maintain spontaneous natural airway breathing during anesthesia, and its analgesic and anesthetic effects are comparable to those of thiopentone/halothane. Propofol/ketamine is appropriate for pediatric herniorrhaphy and hydrocelectomy. It can be recommended for pediatric ambulatory surgery.
全静脉麻醉最近已可用于门诊手术。它具有减少挥发性麻醉剂造成的空气污染以及减少手术室人员接触挥发性麻醉剂的优点。本研究的目的是比较丙泊酚/氯胺酮（全静脉）麻醉和硫喷妥钠/氟烷（静脉和气体）麻醉用于儿童疝修补术或鞘膜积液切除术的麻醉特性。60名年龄在2至7岁、计划进行疝修补术或鞘膜积液切除术的儿童被分为两组。丙泊酚/氯胺酮组（第1组）静脉注射负荷剂量的丙泊酚3mg/kg，随后以200μg/kg/分钟的速度输注丙泊酚；根据需要给予额外的1mg/kg丙泊酚推注剂量，或根据需要将输注剂量增加或减少33μg/kg/分钟。在疝修补术或鞘膜积液切除术术前2至3分钟静脉注射氯胺酮1mg/kg，以增强丙泊酚的镇痛和麻醉效果。硫喷妥钠/氟烷组（第2组）静脉注射硫喷妥钠6mg/kg，随后使用面罩吸入40%氧气和氟烷。第2组患者在间歇性辅助下维持自主呼吸，第1组患者在麻醉期间维持自主自然气道呼吸。第2组患者术后评估量表的评分较高，表明麻醉恢复特性较差，但差异不显著。第1组（12/32）注射时疼痛比第2组（2/28）更频繁。第2组（6/28）呕吐发生率显著高于第1组（0/32）。我们得出结论，丙泊酚/氯胺酮可使患者在麻醉期间维持自主自然气道呼吸，其镇痛和麻醉效果与硫喷妥钠/氟烷相当。丙泊酚/氯胺酮适用于小儿疝修补术和鞘膜积液切除术。它可推荐用于小儿门诊手术。
