Comparison of propofol and desflurane for postanaesthetic morbidity in patients undergoing surgery for aneurysmal SAH: a randomized clinical trial
Comparison of propofol and desflurane for postanaesthetic morbidity in patients undergoing surgery for aneurysmal SAH: a randomized clinical trial
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DOI：
10.1007/s00540-018-2474-z
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发表时间：
2018-04-01
影响因子：
2.8
通讯作者：
Singla, Navneet
中科院分区：
文献类型：
--
作者：
Bhardwaj, Avanish;Bhagat, Hemant;Singla, Navneet
蛛网膜下腔出血（SAH）后的蛛网膜夹闭术是一个独特的麻醉挑战。然而，缺乏关于麻醉剂对这些患者影响的数据。本研究的目的是评价丙泊酚相对于地氟醚在治疗蛛网膜下腔出血术后并发症方面的优越性。70例世界神经外科医师联合会I级和II级患者随机分为丙泊酚组（n = 35）和地氟醚组（n = 35）。丙泊酚组以丙泊酚/芬太尼维持麻醉，地氟醚组以地氟醚/芬太尼维持麻醉。术中评估颈静脉血氧饱和度（SjVO（2））和脑松弛。从停用麻醉剂开始，记录睁眼时间、对口头命令的反应和拔管时间。比较两组患者术后住院时间和出院时改良兰金评分（MRS），丙泊酚组中位术后住院时间为9（6，14）d，地氟醚组中位术后住院时间为9（7，12）d（P = 0.671）。丙泊酚组18例患者和地氟烷组14例患者结局良好（改良兰金评分0-1; P = 0.453）。两种麻醉剂在术中血流动力学、大脑松弛、睁眼时间、对口头命令的反应和拔管时间方面相似（P > 0.05）。地氟醚组的高血压发生率更高（P = 0.007）。地氟醚组术中SjVO（2）值显著高于地氟醚组（P < 0.05）。
Surgery for aneurysmal clipping after subarachnoid haemorrhage (SAH) poses a unique anaesthetic challenge. However, data on the influence of anaesthetic agents in these patients are lacking. The study aims to evaluate the superiority of propofol over desflurane for postanaesthetic morbidity in patients undergoing surgery following aneurysmal SAH.Seventy World Federation of Neurosurgeons Grade I and II patients were randomized into propofol (n = 35) and desflurane groups (n = 35). Anaesthesia was maintained with propofol/fentanyl in propofol group and desflurane/fentanyl in the desflurane group. Jugular venous oxygen saturation (SjVO(2)) and brain relaxation were assessed intraoperatively. Time to eye opening, response to verbal commands, and extubation were noted from the time of discontinuing the anaesthetic agent. Duration of postoperative hospital stay and modified Rankin score (MRS) at discharge were subsequently compared.Median postoperative hospital stay was 9 (6, 14) days with use of propofol and 9 (7, 12) days in desflurane group (P = 0.671). 18 patients in the propofol group and 14 patients in the desflurane group had good outcome (modified Rankin score 0-1; P = 0.453). Both the anaesthetics were similar in terms of intraoperative haemodynamics, brain relaxation, time to eye opening, response to verbal commands, and extubation time (P > 0.05). Emergence hypertension was more in the desflurane group (P = 0.007). The intraoperative SjVO(2) values were significantly higher in the desflurane group (P < 0.05).Propofol and desflurane are comparable in terms of postoperative morbidity in patients undergoing aneurysm neck clipping following SAH.