Inhalational versus Intravenous Induction of Anesthesia in Children with a High Risk of Perioperative Respiratory Adverse Events
Inhalational versus Intravenous Induction of Anesthesia in Children with a High Risk of Perioperative Respiratory Adverse Events
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DOI：
10.1097/aln.0000000000002152
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发表时间：
2018-06-01
期刊：
影响因子：
8.8
通讯作者：
von Ungern-Sternberg, Britta S.
中科院分区：
文献类型：
--
作者：
Ramgolam, Anoop;Hall, Graham L.;von Ungern-Sternberg, Britta S.
背景：有限的证据表明，与吸入七氟醚麻醉诱导相比，静脉丙泊酚用于麻醉诱导的儿童围手术期呼吸道不良事件的发生率较低。限制这些事件可以缩短恢复时间，减少手术等待名单和医疗成本。这项单中心开放随机对照试验评估了麻醉诱导技术对这些事件高危儿童围手术期呼吸不良事件发生的影响。方法：选择至少有两个临床相关呼吸不良事件危险因素且被认为适合两种麻醉诱导方法的儿童(N=300；0~8岁)，随机分为静脉注射异丙酚或吸入七氟醚。结果：在调整了年龄、性别、美国麻醉医师协会的身体状况和体重后，静脉注射异丙酚的儿童发生围手术期呼吸不良事件的可能性明显低于吸入七氟醚的儿童(39/149vs./149，相对危险度[RR]；麻醉诱导时呼吸道不良反应发生率：16/149vs.47/149[32%]，RR：3.06，95%CI：1.8~5.2，P<；0.001)。结论：临床适用时，麻醉医师应考虑使用静脉丙泊酚诱导技术。
Background: Limited evidence suggests that children have a lower incidence of perioperative respiratory adverse events when intravenous propofol is used compared with inhalational sevoflurane for the anesthesia induction. Limiting these events can improve recovery time as well as decreasing surgery waitlists and healthcare costs. This single center open-label randomized controlled trial assessed the impact of the anesthesia induction technique on the occurrence of perioperative respiratory adverse events in children at high risk of those events.Methods: Children (N = 300; 0 to 8 yr) with at least two clinically relevant risk factors for perioperative respiratory adverse events and deemed suitable for either technique of anesthesia induction were recruited and randomized to either intravenous propofol or inhalational sevoflurane. The primary outcome was the difference in the rate of occurrence of perioperative respiratory adverse events between children receiving intravenous induction and those receiving inhalation induction of anesthesia.Results: Children receiving intravenous propofol were significantly less likely to experience perioperative respiratory adverse events compared with those who received inhalational sevoflurane after adjusting for age, sex, American Society of Anesthesiologists physical status and weight (perioperative respiratory adverse event; 39/149 [26%] vs. 64/149 [43%], relative risk [RR]; 1.7, 95% Cl: 1.2 to 2.3, P = 0.002, respiratory adverse events at induction: 16/149 [11%] vs. 47/149 [32%], RR: 3.06, 95% Cl: 1.8 to 5.2, P < 0.001).Conclusions: Where clinically appropriate, anesthesiologists should consider using an intravenous propofol induction technique in children who are at high risk of experiencing perioperative respiratory adverse events.