Propofol versus isoflurane for endoscopic sinus surgery
Propofol versus isoflurane for endoscopic sinus surgery
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DOI：
10.1016/s0196-0709(99)90018-2
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发表时间：
1999-03-01
影响因子：
2.5
通讯作者：
Koerschgen, ME
中科院分区：
文献类型：
--
作者：
Pavlin, JD;Colley, PS;Koerschgen, ME
目的：先前的一项回顾性研究报告称，与异氟醚相比，异丙酚麻醉可以减少鼻内窥镜手术中的出血。我们进行了一项前瞻性研究，以比较异丙酚和异氟醚对鼻内窥镜手术中出血量和外科医生对手术条件的主观评估的影响。患者和方法：在获得机构审查委员会批准和书面知情同意后，56例接受鼻内窥镜手术的患者被随机分配到异丙酚(n=30)或异氟醚(n=26)+一氧化二氮-氧气和阿芬太尼。根据吸引罐中的血红蛋白浓度计算失血量。一名对麻醉剂视而不见的外科医生执行了每一项手术，并对出血情况进行了如下评估：1、没有出血；2、轻度出血；3、出血干扰了手术条件和更换麻醉剂的原因；4、无法忍受的出血，需要改变手术计划。两组结果比较采用卡方检验、非配对t检验、Mann-Whitney U检验和排列检验。结果：异丙酚组平均出血评分随时间推移而减少(P=0.02)，尤其是在筛窦和蝶窦手术中(P=0.03)，且异丙酚组平均出血评分<2的患者比例较少(30%比54%；P=0.033)。异丙酚组直到出院回家或在医院病床上有限停留的时间也较短(183比243分钟；P=0.019)。结论：在我们的研究中，两种麻醉剂的手术失血量总体上是相同的，但异丙酚似乎在主观改善手术条件方面具有优势，特别是在筛窦和蝶窦。《耳鼻喉科杂志》1999；20：96-101。版权所有(C)1999年，由W.B.Saunders公司提供)。
Purpose: A previous retrospective study reported that propofol anesthesia decreased bleeding during endoscopic sinus surgery compared with isoflurane. We performed a prospective study to compare the effects of propofol versus isoflurane on measured blood loss and the surgeon's subjective assessment of operating conditions during endoscopic sinus surgery.Patients and Methods: After receiving institutional review board approval and written informed consent, 56 patients undergoing endoscopic sinus surgery were randomly assigned to receive propofol (n = 30) or isoflurane (n = 26) supplemented with nitrous oxide-oxygen and alfentanil. Blood loss was calculated from the hemoglobin concentration in suction canisters. One surgeon, who was blinded to the anesthetic agent, performed every procedure and assessed bleeding as follows: 1, no bleeding; 2, modest bleeding; 3, bleeding interfering with operating conditions and cause for an agent switch; and 4, intolerable bleeding requiring a change in surgical plan. Results were compared in the two anesthetic groups using chi-squared test, unpaired t-test, Mann-Whitney U test, and a permutation test. A P of .05 was considered significant.Results: Mean bleeding scores were less over time (P = .02) with propofol anesthesia, particularly in surgery in the ethmoid and sphenoid sinuses (P = .03), and the proportion of patients with a mean score >2 was less in the propofol group (30% v 54%; P = .033). Time until discharge to home or to a limited stay in a hospital bed was also less in the propofol group (183 v 243 minutes; P = .019).Conclusion: In our study, surgical blood loss was the same for both anesthetic agents overall, but propofol appeared to offer an advantage in terms of subjective improvement in operating conditions, particularly in the ethmoid and sphenoid sinuses. (Am J Otolaryngol 1999;20:96-101. Copyright (C) 1999 by W.B. Saunders Company).