Song D, Whitten C W, White P F, Yu S Y, Zarate E
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 75235-9068, USA.
Anesthesiology. 1998 Oct;89(4):838-43. doi: 10.1097/00000542-199810000-00007.
Controversy exists regarding the effectiveness of propofol to prevent postoperative nausea and vomiting. This prospective, randomized, single-blinded study was designed to evaluate the antiemetic effectiveness of 0.5 mg/kg propofol when administered intravenously after sevoflurane- compared with desflurane-based anesthesia.
Two hundred fifty female outpatients undergoing laparoscopic cholecystectomy were assigned randomly to one of four treatment groups. All patients were induced with intravenous doses of 2 mg midazolam, 2 microg/kg fentanyl, and 2 mg/kg propofol and maintained with either 1-4% sevoflurane (groups 1 and 2) or 2-8% desflurane (groups 3 and 4) in combination with 65% nitrous oxide in oxygen. At skin closure, patients in groups 1 and 3 were administered 5 ml intravenous saline, and patients in groups 2 and 4 were administered 0.5 mg/kg propofol intravenously. Recovery times were recorded from discontinuation of anesthesia to awakening, orientation, and readiness to be released home. Postoperative nausea and vomiting and requests for antiemetic rescue medication were evaluated during the first 24 h after surgery.
Propofol, in an intravenous dose of 0.5 mg/kg, administered at the end of a sevoflurane-nitrous oxide or desflurane-nitrous oxide anesthetic prolonged the times to awakening and orientation by 40-80% and 25-30%, respectively. In group 2 (compared with groups 1, 3, and 4), the incidences of emesis (22% compared with 47%, 53%, and 47%) and requests for antiemetic rescue medication (19% compared with 42%, 50%, and 47%) within the first 6 h after surgery were significantly lower, and the time to home-readiness was significantly shorter in duration (216 +/- 50 min vs. 249 +/- 49 min, 260 +/- 88 min, and 254 +/- 72 min, respectively).
A subhypnotic intravenous dose of propofol (0.5 mg/kg) administered at the end of outpatient laparoscopic cholecystectomy procedures was more effective in preventing postoperative nausea and vomiting after a sevoflurane-based (compared with a desflurane-based) anesthetic.
关于丙泊酚预防术后恶心呕吐的有效性存在争议。本前瞻性、随机、单盲研究旨在评估在七氟醚麻醉与地氟醚麻醉后静脉注射0.5mg/kg丙泊酚的止吐效果。
250例接受腹腔镜胆囊切除术的女性门诊患者被随机分配到四个治疗组之一。所有患者均静脉注射2mg咪达唑仑、2μg/kg芬太尼和2mg/kg丙泊酚诱导麻醉，并用1-4%七氟醚（第1组和第2组）或2-8%地氟醚（第3组和第4组）联合65%氧化亚氮-氧气维持麻醉。在皮肤缝合时，第1组和第3组患者静脉注射5ml生理盐水，第2组和第4组患者静脉注射0.5mg/kg丙泊酚。记录从停止麻醉到苏醒、定向和准备出院的恢复时间。评估术后24小时内的术后恶心呕吐情况以及使用止吐急救药物的需求。
在七氟醚-氧化亚氮或地氟醚-氧化亚氮麻醉结束时静脉注射0.5mg/kg丙泊酚，分别使苏醒和定向时间延长40-80%和25-30%。在第2组（与第1组、第3组和第4组相比），术后6小时内呕吐发生率（22%对比47%、53%和47%）和使用止吐急救药物的需求（19%对比42%、50%和47%）显著更低，且准备出院时间显著更短（分别为216±50分钟对比249±-49分钟、260±88分钟和254±72分钟）。
门诊腹腔镜胆囊切除术后静脉注射亚催眠剂量的丙泊酚（0.5mg/kg）在七氟醚麻醉（与地氟醚麻醉相比）后预防术后恶心呕吐更有效。
