Speed of recovery and side-effect profile of sevoflurane sedation compared with midazolam
Speed of recovery and side-effect profile of sevoflurane sedation compared with midazolam
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DOI：
10.1097/00000542-200101000-00018
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发表时间：
2001-01-01
期刊：
影响因子：
8.8
通讯作者：
Philip, BK
中科院分区：
文献类型：
--
作者：
Ibrahim, AE;Ghoneim, MM;Philip, BK
背景资料：区域或局部麻醉的外科手术镇静通常通过静脉给药实现，而挥发性麻醉剂的使用受到限制。七氟醚因其无刺激性、快速诱导和快速消除的特点而被建议用于镇静。本研究的目的是评估七氟烷镇静与咪达唑仑相比的质量、恢复和副作用。方法：173名接受局部或区域麻醉手术的患者参加了一项多中心、开放标签、随机研究，比较了七氟烷与咪达唑仑的镇静效果。将镇静水平滴定至观察者警觉性-镇静评分评估为3（对声音反应缓慢）。恢复客观评估观察员的评估警觉镇静，数字符号替代试验（DSST），记忆分数，和主观的视觉模拟scales.Results：显着更多的患者在七氟烷组已转换为全身麻醉，因为过度运动（18七氟烷和2咪达唑仑，P = 0.043）。在其余患者中，141例可评估疗效和恢复数据（93例七氟烷和48例咪达唑仑）。七氟烷和咪达唑仑产生剂量相关的镇静作用。七氟烷组患者在恢复期的DSST和记忆评分较高。术后30 min时，76%（七氟烷）与35%（咪达唑仑）恢复至基线DSST（P < 0.05）。观察到七氟烷的兴奋-去抑制频率更高（15 [16%] vs.咪达唑仑; P = 0.008）。结论：与咪达唑仑相比，七氟烷用于镇静可更快地恢复认知功能（通过DSST和记忆评分测量）。然而，七氟烷用于镇静的并发症是术中兴奋的高发生率。
Background: Sedation for surgical procedures performed with regional or local anesthesia has usually been achieved with intravenous medications, whereas the use of volatile anesthetics has been limited. The use of sevoflurane for sedation has been suggested because of its characteristics of nonpungency, rapid induction, and quick elimination. The purpose of this investigation was to assess the quality, recovery, and side effects of sevoflurane sedation compared with midazolam.Methods: One hundred seventy-three patients undergoing surgery with local or regional anesthesia were enrolled in a multicenter, open-label, randomized investigation comparing sedation with sevoflurane versus midazolam. Sedation level was titrated to an Observer's Assessment of Alertness-Sedation score of 3 (responds slowly to voice). Recovery was assessed objectively by Observer's Assessment of Alertness-Sedation, Digit Symbol Substitution Test (DSST), and memory scores, and subjectively by visual analog scales.Results: Significantly more patients in the sevoflurane group had to be converted to general anesthesia because of excessive movement (18 sevoflurane and 2 midazolam; P = 0.043). Of remaining patients, 141 were assessable for efficacy and recovery data (93 sevoflurane and 48 midazolam). Sevoflurane and midazolam produced dose-related sedation. Sevoflurane patients had higher DSST and memory scores during recovery. Seventy-six percent (sevoflurane) compared with 35% (midazolam) returned to baseline DSST at 30 min postoperatively (P < 0.05). More frequent excitement-disinhibition was observed with sevoflurane (15 [16%] vs. midazolam; P = 0.008).Conclusions: Sevoflurane for sedation produces faster recovery of cognitive function as measured by DSST and memory scores compared with midazolam. However, sevoflurane for sedation is complicated by a high incidence of intraoperative excitement.