Postoperative recovery after desflurane, propofol, or isoflurane anesthesia among morbidly obese patients: A prospective, randomized study
Postoperative recovery after desflurane, propofol, or isoflurane anesthesia among morbidly obese patients: A prospective, randomized study
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DOI：
10.1213/00000539-200009000-00041
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发表时间：
2000-09-01
影响因子：
5.7
通讯作者：
Desmonts, JM
中科院分区：
文献类型：
--
作者：
Juvin, P;Vadam, C;Desmonts, JM
肥胖患者麻醉后的恢复可能会受到影响。由于其药理学特性，地氟烷可能使这些患者术后快速恢复。我们比较了36例肥胖患者在腹腔镜胃成形术中随机接受地氟烷、丙泊酚或异氟烷维持麻醉的术后恢复情况。以丙泊酚和琥珀胆碱IV诱导麻醉，并以罗库溴铵、阿芬太尼、吸入性氧化亚氮和研究药物维持。立即恢复（即，从停止麻醉到拔管、睁眼和说出自己名字的时间）。在麻醉后监护室（PACU）入院时，记录动脉饱和度和患者活动能力。在PACU中，通过使用镇静和心理测量评估，术后30，60和120分钟测量中间恢复。使用Kruskal-Wallis和卡方检验比较组间数据。结果报告为平均值+/- SD。与地氟烷相比，P < 0.05被认为是显著的。与丙泊酚或异氟烷相比，地氟烷后即刻恢复更快，更一致（拔管时间分别为6 +/- 1 min、13 +/- 8 min [P < 0.05，与地氟烷相比]和12 +/- 6 min [P < 0.05，与地氟烷相比]）。在PACU入院时，地氟烷后SpO（2）值明显高于异氟烷或丙泊酚后，患者活动性明显改善。在术后30和120 min时，地氟烷镇静作用明显减弱。在病态肥胖患者中，地氟烷麻醉后的术后即刻和中期恢复比丙泊酚或异氟烷麻醉后更快。地氟烷的这一优势在术后至少持续2小时，并与患者活动性改善和术后去饱和发生率降低相关。
Recovery from anesthesia might be compromised in obese patients. Because of its pharmacological properties, desflurane might allow rapid postoperative recovery for these patients. We compared postoperative recovery for 36 obese patients randomized to receive either desflurane, propofol, or isoflurane to maintain anesthesia during laparoscopic gastroplasties. Anesthesia was induced with propofol and succinylcholine IV and was maintained with rocuronium, alfentanil, inhaled nitrous oxide, and the study drug. Immediate recovery (i.e., times from the discontinuation of anesthesia to tracheal extubation, eye opening, and the ability to state one's name) was measured. At the time of postanesthesia care unit (PACU) admission, arterial saturation and the ability of patients to move were recorded. In the PACU, intermediate recovery was measured by using sedation and psychometric evaluations, 30, 60, and 120 min postoperatively. Data were compared between groups by using the Kruskal-Wallis and chi(2) tests. Results were reported as means +/- SD. P < 0.05, compared with desflurane, was considered significant. Immediate recovery occurred faster, and was more consistent, after desflurane than after propofol or isoflurane (times to extubation were 6 +/- 1 min, 13 +/- 8 min [P < 0.05, compared with desflurane], and 12 +/- 6 min [P < 0.05, compared with desflurane], respectively). At PACU admission, SpO(2) values were significantly higher and patient mobility was significantly better after desflurane than after isoflurane or propofol Sedation was significantly less pronounced with desflurane at 30 and 120 min postoperatively. In morbidly obese patients, postoperative immediate and intermediate recoveries are more rapid after desflurane than after propofol or isoflurane anesthesia. This advantage of desflurane persists at least for 2 h after surgery and is associated with both an improvement in patient mobility and a reduced incidence of postoperative desaturation.