Johns F R, Sandler N A, Buckley M J, Herlich A
Department of Oral and Maxillofacial Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, PA 15213, USA.
J Oral Maxillofac Surg. 1998 Oct;56(10):1124-7; discussion 1127-8. doi: 10.1016/s0278-2391(98)90749-2.
Methohexital and propofol have been shown to be effective agents for continuous intravenous infusion to produce conscious sedation during oral surgical procedures. The current study was conducted to compare these techniques for intraoperative cardiopulmonary stability, patient cooperation, amnesia, comfort, recovery time, and postoperative nausea and vomiting.
Seventy ASA Class I or Class II patients between the ages of 18 and 40 years, scheduled for surgical extraction of impacted third molars, were entered into the study. Thirty-five patients were assigned to group A (methohexital) and 35 were assigned to group B (propofol). Intravenous sedation was accomplished using premedication with 1.5 microg/kg of fentanyl and 0.05 mg/kg of midazolam followed by the continuous infusion of methohexital or propofol at a rate of 50 microg/kg/min. The infusion was then titrated to 100 microg/kg/min to accomplish a level of sedation in which the eyes were closed and the patients were responsive to verbal commands. Subjects were monitored for variability of heart rate, blood pressure, oxygen saturation, amnesia, comfort, cooperation, nausea and vomiting, and recovery time based on cognitive, perceptual, and psychomotor tests.
There was no statistical difference between the two medication groups except for heart rate, which was found to increase by 11 beats/min for group A and only three beats/min in group B.
A continuous infusion technique using either methohexital or propofol (50 to 100 microg/kg/min) was found to be safe and effective, with no clinically significant differences in cooperation, cardiopulmonary stability, recovery time, amnesia, comfort, and the incidence of nausea or vomiting. However, the cost-effectiveness of methohexital is superior to that of propofol.
已证明美索比妥和丙泊酚是在口腔外科手术期间进行持续静脉输注以产生清醒镇静的有效药物。进行本研究以比较这些技术在术中心肺稳定性、患者配合度、遗忘效果、舒适度、恢复时间以及术后恶心和呕吐方面的差异。
70例年龄在18至40岁之间、计划接受阻生第三磨牙手术拔除的美国麻醉医师协会（ASA）I级或II级患者纳入本研究。35例患者被分配到A组（美索比妥），35例被分配到B组（丙泊酚）。静脉镇静通过先给予1.5微克/千克芬太尼和0.05毫克/千克咪达唑仑进行预处理，随后以50微克/千克/分钟的速率持续输注美索比妥或丙泊酚来实现。然后将输注速率滴定至100微克/千克/分钟，以达到闭眼且患者对言语指令有反应的镇静水平。基于认知、感知和心理运动测试，对受试者的心率、血压、血氧饱和度、遗忘效果、舒适度、配合度、恶心和呕吐以及恢复时间的变异性进行监测。
除心率外，两组药物之间无统计学差异，A组心率增加11次/分钟，B组仅增加3次/分钟。
发现使用美索比妥或丙泊酚（50至100微克/千克/分钟）的持续输注技术安全有效，在配合度、心肺稳定性、恢复时间、遗忘效果、舒适度以及恶心或呕吐发生率方面无临床显著差异。然而，美索比妥的成本效益优于丙泊酚。
