Desflurane Versus Sevoflurane for Maintenance of Outpatient Anesthesia: The Effect on Early Versus Late Recovery and Perioperative Coughing
Desflurane Versus Sevoflurane for Maintenance of Outpatient Anesthesia: The Effect on Early Versus Late Recovery and Perioperative Coughing
复制标题
地氟烷与七氟烷用于门诊麻醉维持：对早期恢复与晚期恢复以及围手术期咳嗽的影响
DOI：
10.1213/ane.0b013e3181adc21a
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发表时间：
2009
影响因子：
5.7
通讯作者：
A. Zaentz
中科院分区：
文献类型：
--
作者：
Paul F. White;Jun Tang;R. Wender;R. Yumul;O Jameson Stokes;Alexander Sloninsky;Robert Naruse;R. Kariger;E. Norel;S. Mandel;T. Webb;A. Zaentz
背景技术背景：地氟烷与七氟烷用于门诊麻醉维持时的相对围手术期获益存在争议。尽管研究一致证明地氟烷（与七氟烷相比）的苏醒更快，但尚未明确确定该差异对后期恢复终点的影响。此外，地氟烷（与七氟烷相比）对咳嗽发生率的影响也存在争议。方法：我们将130例需要全麻的浅表外科手术门诊患者随机分为两个维持麻醉治疗组。所有患者均用丙泊酚2 mg/kg IV诱导，并在放置喉罩气道后，用含1%-3%七氟烷或3%-8%地氟烷的空气/氧气混合物维持麻醉。改变吸入的挥发性麻醉剂浓度，以维持血流动力学稳定性和50 - 60的双频指数值。通过局部麻醉浸润和酮咯酸（30 mg IV）进行镇痛。止吐预防包括在手术结束时联合使用昂丹司琼（4 mg）、地塞米松（4 mg）和甲氧氯普胺（10 mg）。评估包括睁眼的恢复时间、对命令的反应、定向、14分的快速通道评分、首次口服、坐位、站立、无辅助行走和实际出院。患者对麻醉的满意度、术后第一天恢复正常活动的能力、不良副作用（例如，咳嗽、有目的的运动、氧饱和度下降<90%、咽喉痛、术后恶心和呕吐）以及术后镇痛和止吐药物的需求在术后早期和出院后最初24小时内记录。结果：两个研究组具有可比的人口统计学特征。尽管地氟烷组围手术期咳嗽的总体发生率较高（60% vs七氟烷组32%，P <0.05），但实际给予挥发性麻醉剂期间的咳嗽发生率（即，维持期）在两组之间没有差异。地氟烷后麻醉苏醒更快;然而，所有患者在离开手术室前均达到了快速恢复标准（快速恢复评分≥ 12）。最后，两个麻醉剂组的出院时间（七氟烷组为90 ± 31 min，地氟烷组为98 ± 35 min）和术后第一天能够恢复正常活动的患者百分比（七氟烷组为48%，地氟烷组为60%）无显著差异。结论：使用地氟烷维持麻醉与苏醒更快和咳嗽发生率更高相关。尽管地氟烷的初始恢复更快，但在后期恢复期，两种挥发性麻醉剂之间无显著差异。这两种挥发性麻醉剂应可用于门诊麻醉。
BACKGROUND: There is controversy regarding the relative perioperative benefits of desflurane versus sevoflurane when used for maintenance of anesthesia in the ambulatory setting. Although studies have consistently demonstrated a faster emergence with desflurane (versus sevoflurane), the impact of this difference on the later recovery end points has not been definitively established. Furthermore, the effect of desflurane (versus sevoflurane) on the incidence of coughing is also controversial. METHODS: We randomized 130 outpatients undergoing superficial surgical procedures requiring general anesthesia to one of two maintenance anesthetic treatment groups. All patients were induced with propofol, 2 mg/kg IV, and after placement of a laryngeal mask airway, anesthesia was maintained with either sevoflurane 1%–3% or desflurane 3%–8% in an air/oxygen mixture. The inspired concentration of the volatile anesthetic was varied to maintain hemodynamic stability and a Bispectral Index value of 50–60. Analgesia was provided with local anesthetic infiltration and ketorolac (30 mg IV). Antiemetic prophylaxis consisted of a combination of ondansetron (4 mg), dexamethasone (4 mg), and metoclopramide (10 mg) at the end of surgery. Assessments included recovery times to eye opening, response to commands, orientation, fast-track score of 14, first oral intake, sitting, standing, ambulating unassisted, and actual discharge. Patient satisfaction with anesthesia, the ability to resume normal activities on the first postoperative day, adverse side effects (e.g., coughing, purposeful movement, oxygen desaturation <90%, sore throat, postoperative nausea, and vomiting), and the requirement for postoperative analgesic and antiemetic drugs were recorded in the early postoperative period and during the initial 24-h period after discharge. RESULTS: The two study groups had comparable demographic characteristics. Although the overall incidence of coughing during the perioperative period was higher in the desflurane group (60% versus 32% in the sevoflurane group, P < 0.05), the incidences of coughing during the actual administration of the volatile anesthetics (i.e., the maintenance period) did not differ between the two groups. Emergence from anesthesia was more rapid after desflurane; however, all patients achieved fast-track recovery criteria (fast-track score ≥12) before leaving the operating room. Finally, the time to discharge home (90 ± 31 min in sevoflurane and 98 ± 35 min in desflurane, respectively) and the percentage of patients able to resume normal activities on the first postoperative day (sevoflurane 48% and desflurane 60%) did not differ significantly between the two anesthetic groups. CONCLUSIONS: Use of desflurane for maintenance of anesthesia was associated with a faster emergence and a higher incidence of coughing. Despite the faster initial recovery with desflurane, no significant differences were found between the two volatile anesthetics in the later recovery period. Both volatile anesthetics should be available for ambulatory anesthesia.