Fredman B, Zohar E, Philipov A, Olsfanger D, Shalev M, Jedeikin R
Department of Anesthesiology and Intensive Care, Meir Hospital, Kfar Saba, Israel.
J Clin Anesth. 1998 Dec;10(8):623-30. doi: 10.1016/s0952-8180(98)00099-3.
To compare the induction and recovery profiles of three combinations of general anesthesia when used as an alternative to spinal anesthesia for elderly patients.
Randomized, prospective, open-label study.
Large referral hospital.
100 [ASA physical status I, II, and III] patients over 60 years of age undergoing brief transurethral surgery.
In Groups Propofol-Propofol (P-P), Propofol-Isoflurane (P-I), and Propofol-Desflurane (P-D), anesthesia was induced with fentanyl (1 to 2 micrograms/kg i.v.) and propofol (1.0 to 2.0 mg/kg i.v.) and maintained with 70% nitrous oxide in oxygen and either a propofol infusion (75 to 150 micrograms/kg/min) or isoflurane (end-tidal 0.7% to 1.2%) or desflurane (end-tidal 1% to 4%), respectively. After induction, a laryngeal mask airway was placed and spontaneous ventilation was maintained. In Group Spinal (S), 1.5 ml 4% lidocaine (60 mg), in an equal volume of 10% dextrose, was administered intrathecally.
Induction and recovery characteristics were compared. Induction with propofol was technically easier and significantly (medp < 0.0001) faster (4.6 +/- 1.7 min, 4.7 +/- 2.2 min, and 3.8 +/- 1.4 min for Groups P-P, P-I, and P-D, respectively) than induction of spinal anesthesia (9.3 +/- 3.4 min). During the induction period, mean arterial blood pressure and heart rate were significantly higher in Group S. Emergence, extubation, and orientation times were similar among the general anesthesia treatment groups. In Group S, patient-generated pain scores were lower (p < 0.05) and recovery room admission longer (p < 0.001). Time to return to baseline digit symbol substitution test (DSST) scores was marginally improved in Groups P-P and P-D when compared to Group P-I. Postoperative nausea, sleepiness, anxiety, and coordination were unaffected by the treatment modality.
General anesthesia with propofol and desflurane facilitates shorter induction and recovery times without adversely affecting patient comfort. Therefore, this technique may be preferable to spinal anesthesia for elderly patients undergoing short transurethral surgical procedures.
比较三种全身麻醉组合用于老年患者替代脊髓麻醉时的诱导和恢复情况。
随机、前瞻性、开放标签研究。
大型转诊医院。
100例年龄超过60岁、美国麻醉医师协会（ASA）身体状况为I、II和III级、接受简短经尿道手术的患者。
在丙泊酚-丙泊酚组（P-P）、丙泊酚-异氟烷组（P-I）和丙泊酚-地氟烷组（P-D）中，麻醉诱导采用芬太尼（静脉注射1至2微克/千克）和丙泊酚（静脉注射1.0至2.0毫克/千克），并分别用70%氧化亚氮-氧气混合气体维持，同时分别持续输注丙泊酚（75至150微克/千克/分钟）、吸入异氟烷（呼气末浓度0.7%至1.2%）或地氟烷（呼气末浓度1%至4%）。诱导后，放置喉罩气道并维持自主通气。在脊髓麻醉组（S）中，经鞘内注射1.5毫升4%利多卡因（60毫克）与等量10%葡萄糖的混合液。
比较诱导和恢复特征。丙泊酚诱导在技术上更简便，且比脊髓麻醉诱导显著更快（P-P组、P-I组和P-D组分别为4.6±1.7分钟、4.7±2.2分钟和3.8±1.4分钟，脊髓麻醉组为9.3±3.4分钟，P<0.0001）。诱导期间，S组的平均动脉血压和心率显著更高。全身麻醉治疗组之间的苏醒、拔管和定向时间相似。在S组中，患者产生的疼痛评分更低（P<0.05），恢复室留观时间更长（P<0.001）。与P-I组相比，P-P组和P-D组恢复至基线数字符号替换试验（DSST）评分的时间略有改善。术后恶心、嗜睡、焦虑和协调性不受治疗方式影响。
丙泊酚和地氟烷全身麻醉可缩短诱导和恢复时间，且不影响患者舒适度。因此，对于接受简短经尿道手术的老年患者，该技术可能优于脊髓麻醉。
