Statistical Modeling of Average and Variability of Time to Extubation for Meta-Analysis Comparing Desflurane to Sevoflurane
Statistical Modeling of Average and Variability of Time to Extubation for Meta-Analysis Comparing Desflurane to Sevoflurane
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DOI：
10.1213/ane.0b013e3181b5dcb7
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发表时间：
2010-02-01
影响因子：
5.7
通讯作者：
Epstein, Richard H.
中科院分区：
文献类型：
--
作者：
Dexter, Franklin;Bayman, Emine O.;Epstein, Richard H.
背景：理想的麻醉剂或技术的恢复曲线应该是快速的(例如，从手术结束到拔管平均5分钟)，几乎没有变化(例如，总是4-7分钟)。我们使用麻醉信息管理系统(AIMS)的数据来学习如何模拟从手术结束到拔管的时间。我们将这些知识应用于比较地氟烷和七氟醚拔管时间试验的荟萃分析。方法：研究对象为95名外科医生，共32,792例，包括气管插管、手术室拔管(OR)和使用挥发性麻醉剂(S)。荟萃分析包括截至2008年的29个随机对照试验，比较地氟烷和七氟醚的拔管时间。用随机效应荟萃分析和贝叶斯方法研究拔管时间的百分比差异。结果：(偏态)威布尔分布比(对称)正态分布更适合拔管时间。药物选择对拔管时间的平均值和标准差的影响几乎成比例，如不变的变异系数(29项研究中有26项P>；0.10)和无显著差异(七氟醚地氟烷=-1%，95%可信区间[CI]-3%至1%，P=0.22)。应用这些发现，地氟醚使平均拔管时间缩短了25%(95%可信区间为17%-32%，P<；0.0001)，标准差缩短了21%(95%可信区间为16%-26%)。为了评估延长拔管时间的无形成本(例如，沮丧的等待外科医生)，我们考虑了15%的AIMS病例，时间为15分钟。这些病例从离开手术室到下一位外科医生开始手术的时间平均延长了4.9min(95%CI2.7-7.1min，P<；0.0001)。平均拔管时间和标准差减少20%~25%，拔管时间延长的发生率可能降低71%~82%(95%可信区间68%~84%)。结论：地氟烷与七氟醚相比，平均拔管时间和拔管时间变异性降低20%~25%。这些终点的主要经济价值是它们减少了或时间的直接(劳动力)成本。然而，延长拔管的无形成本的减少是真实的，这与随后的延迟有关。拔管时间的平均值和方差的减少可以解释为。并监测使用地氟烷与七氟醚相比延长拔管时间的相应预期减少75%的发生率。(Anesth Analg 2010；110：570-80)
BACKGROUND: The recovery profile of an ideal anesthetic or technique would be fast (e.g., mean of 5 min from end of surgery to extubation) with little variability (e.g., always 4-7 min). We used anesthesia information management system (AIMS) data to learn how to model the time from end of surgery to extubation. We applied that knowledge for meta-analyses of trials comparing extubation times after use of desflurane and sevoflurane.METHODS: AIMS data studied were 32,792 cases performed by 95 surgeons that included tracheal intubation and extubation in the operating room (OR) and use of volatile anesthetic(s). Meta-analysis included the 29 randomized controlled trials through 2008 comparing extubation times with desflurane and sevoflurane. Percentage differences in means and standard deviations were studied using random effects meta-analysis and a Bayesian method.RESULTS: Times to extubation were better fit by (skewed) Weibull distributions than by (symmetric) normal distributions. Drug choice had nearly equally proportional effects on the means and standard deviations of extubation times, as shown by unchanged coefficients of variation (P > 0.10 for 26 of 29 studies) and nonsignificant pooled difference in the coefficient of variation (sevoflurane desflurane = -1%, 95% confidence interval [CI] -3% to 1%, P = 0.22). Applying these findings, desflurane reduced the mean extubation time by 25% (95% CI 17%-32%, P < 0.0001) and standard deviation by 21% (95% CI 16%-26%). To value the intangible costs (e.g., frustrated waiting surgeons) of prolonged extubation times, we considered the 15% of AIMS cases with times > 15 min. These cases averaged 4.9 min longer times from out of the OR to the start of surgery of the surgeon's next case (95% CI 2.7-7.1 min, P < 0.0001). Reduction in the means and standard deviations by 20%-25% would likely reduce incidences of these prolonged extubation times by 71%-82% (95% CI 68%-84%).CONCLUSIONS: Desflurane reduces the average extubation time and the variability of extubation time by 20%-25% relative to sevoflurane. The principal economic value of these end points is their reductions of direct (labor) costs of OR time. However, reductions in intangible costs of prolonged extubation are real, being associated with subsequent delays. Reductions in the average and variance of times to extubation can be interpreted. and monitored in terms of corresponding expected 75% reductions in the incidences of prolonged extubation times by using desflurane relative to sevoflurane. (Anesth Analg 2010;110:570-80)