An Analysis of Anesthesia-Controlled Operating Room Time After Propofol-Based Total Intravenous Anesthesia Compared with Desflurane Anesthesia in Ophthalmic Surgery: A Retrospective Study
An Analysis of Anesthesia-Controlled Operating Room Time After Propofol-Based Total Intravenous Anesthesia Compared with Desflurane Anesthesia in Ophthalmic Surgery: A Retrospective Study
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DOI：
10.1213/ane.0000000000000435
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发表时间：
2014-12-01
影响因子：
5.7
通讯作者：
Lu, Chueng-He
中科院分区：
文献类型：
--
作者：
Wu, Zhi-Fu;Jian, Guan-Shiung;Lu, Chueng-He
背景：麻醉技术有助于减少麻醉控制时间，提高手术室（OR）效率。然而，对于全身麻醉下眼科手术中异丙酚为基础的全静脉麻醉（TIVA）和地氟烷麻醉（DES）技术之间的麻醉控制时间差异知之甚少。我们使用医院数据库进行了一项回顾性分析，以比较通过靶控输注丙泊酚/芬太尼或地氟烷/芬太尼接受TIVA的眼科手术患者的麻醉控制时间。在2010年1月至2011年12月期间进行了麻醉。不同的时间间隔（手术时间，切口到手术完成和敷料的应用;麻醉时间，麻醉开始到拔管;拔管时间，手术完成和敷料应用于拔管;在OR中的时间，到达OR到离开OR;麻醉后护理单元（PACU）停留时间，到达PACU到从PACU到普通病房;比较两种麻醉方法的手术时间、到达手术室到从PACU到普通病房的时间以及术后恶心呕吐的发生率。我们纳入了1405例患者的数据，其中595例接受TIVA，810例接受DES。与DES组相比，TIVA组的拔管时间更快（TIVA-DES = -1.85分钟，99.2%置信区间[CI]，-2.47至-1.23分钟），PACU停留时间更短（TIVA-DES = -3.62分钟，99.2% CI，-6.97至-0.10分钟）。然而，两组之间的总手术时间无显著差异（TIVA-DES = -5.03分钟，99.2% CI，-11.75至1.69分钟）。我们在对手术进行分层时进行了随机效应分析，结果显示TIVA组的拔管时间比DES组快14%（99.2% CI，9%-19%，P < 0.0001），PACU停留时间比DES组快5%（99.2% CI，1%-10%，P = 0.002）。TIVA组发生术后恶心、呕吐和需要补救治疗的患者明显少于DES组（11.3% vs 32.2%，风险差异21.0%，95%CI，16.9%至25.1%，P < 0.001和23.9% vs 54.0%，风险差异30.1%，95%CI，18.3%至42.0%，P = 0.002，结论：在我们医院，与使用DES麻醉进行眼科手术相比，使用TIVA使平均拔管时间至少缩短9%，PACU停留时间缩短1%以上。
BACKGROUND: Anesthetic techniques can contribute to reduction of anesthesia-controlled time to improve operating room (OR) efficiency. However, little is known about the difference in anesthesia-controlled time between propofol-based total IV anesthesia (TIVA) and desflurane anesthesia (DES) techniques for ophthalmic surgery under general anesthesia.METHODS: We performed a retrospective analysis using hospital databases to compare the anesthesia-controlled times of ophthalmic surgery patients receiving either TIVA via target-controlled infusion with propofol/fentanyl or desflurane/fentanyl-based anesthesia between January 2010 and December 2011. The various time intervals (surgical time, incision to surgical completion and application of dressings;.anesthesia time, start of anesthesia to extubation; extubation time, surgery complete and dressings applied to extubation; time in OR, arrival in the OR to departure from the OR; postanesthetic care unit (PACU) stay time, arrival in the PACU to discharge from the PACU to the general ward; and total surgical suite time, arrival in the OR to discharge from the PACU to the general ward) that comprise a patient's hospital stay and the incidence of postoperative nausea and vomiting were compared between the 2 anesthetic techniques.RESULTS: We included data from 1405 patients, with 595 patients receiving TIVA and 810 receiving DES. The extubation time was faster (TIVA-DES = -1.85 minutes, 99.2% confidence interval [Cl], -2.47 to -1.23 minutes) and the PACU stay time was shorter (TIVA-DES = -3.62 minutes, 99.2% Cl, -6.97 to -0.10 minutes) in the TIVA group than in the DES group. However, there was no significant difference in total surgical suite time between groups (TIVA-DES = -5.03 minutes, 99.2% Cl, -11.75 to 1.69 minutes). We performed the random-effects analyses while stratifying for procedure and showed that the extubation time in the TIVA group was faster by 14% (99.2% Cl, 9% to 19%, P < 0.0001) relative to the DES group, and the PACU stay time was faster by 5% (99.2% Cl, 1% to 10%, P = 0.002). Significantly fewer patients suffered postoperative nausea and vomiting and required rescue therapy in the TIVA group than in the DES group (11.3% vs 32.2%, risk difference 21.0%, 95% Cl, 16.9% to 25.1%, P < 0.001 and 23.9% vs 54.0%, risk difference 30.1%, 95% Cl, 18.3% to 42.0%, P = 0.002, respectively).CONCLUSIONS: In our hospital, the use of TIVA reduced the mean time to extubation by at least 9% and PACU stay time by more than 1% when compared with the use of DES anesthesia for ophthalmic surgery.