A comparison between inhalational (Desflurane) and total intravenous anaesthesia (Propofol and dexmedetomidine) in improving postoperative recovery for morbidly obese patients undergoing laparoscopic sleeve gastrectomy: A double-blinded randomised controlled trial
A comparison between inhalational (Desflurane) and total intravenous anaesthesia (Propofol and dexmedetomidine) in improving postoperative recovery for morbidly obese patients undergoing laparoscopic sleeve gastrectomy: A double-blinded randomised controlled trial
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DOI：
10.1016/j.jclinane.2017.12.001
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发表时间：
2018-03-01
影响因子：
6.7
通讯作者：
Ibrahim, Ezzeldin
中科院分区：
文献类型：
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作者：
Elbakry, Abd-Elazeem;Sultan, Wesam-Eldin;Ibrahim, Ezzeldin
研究目的：腹腔镜袖胃切除术通常在全静脉麻醉（TIVA）或使用静脉和吸入药物的平衡麻醉下进行。目前尚不清楚哪种麻醉方案对这组患者更好。本研究比较了地氟醚吸入麻醉技术与使用异丙酚和右美托咪定的TIVA技术。设计：前瞻性、随机、双盲研究。单位：梅诺菲亚大学附属医院。患者：这项随机试验对100名接受腹腔镜袖式胃切除术的病态肥胖患者进行了研究。患者被随机分为两组：一组接受吸入麻醉技术，另一组接受TIVA技术。干预措施：所有患者均接受异丙酚、瑞芬太尼和罗库溴铵诱导的全身麻醉。吸入组采用地氟醚混合氧空气维持麻醉，TIVA组采用异丙酚和右美托咪定静脉输注维持麻醉。测量方法：记录术中生命体征、麻醉恢复时间、术后恶心呕吐、疼痛评分、麻醉后护理单位（PACU）停留时间、术后24 h总镇痛需求及首次排便次数。主要结果TIVA组患者术中心率和平均动脉血压较低（P < 0.0001）。TIVA组术后疼痛评估视觉模拟评分（VAS）较低（P < 0.0001），总镇痛需求较低（P < 0.0001），恶心（P = 0.01）和呕吐（P = 0.03）发生率较低，PACU停留时间较短（P = 0.01）。两组在排便时间方面无显著差异（P = 0.16）。结论：应用异丙酚和右美托咪定的TIVA麻醉方案优于地氟醚吸入麻醉方案用于病态肥胖患者腹腔镜袖式胃切除术。TIVA技术提供了更好的术后恢复，更少的术后副作用和镇痛需求。(C) 2017爱思唯尔公司版权所有。
Study objective: Laparoscopic sleeve gastrectomy is commonly performed under total intravenous anaesthesia (TIVA) or balanced anaesthesia using an intravenous and inhalation agent. It is still unclear which anaesthesia regimen is better for this group of patients. The present study has been conducted to compare the use of the inhalation anaesthesia technique using desflurane with the TIVA technique, using propofol and dexmedetomidine.Design: Prospective, randomised, double-blinded study.Setting: Menoufia Univeristy Hospital.Patients: This randomised trial was carried out on 100 morbidly obese patients undergoing laparoscopic sleeve gastrectomy. The patients were randomised into two equally sized groups: one group received the inhalation anaesthesia technique and the other received the TIVA technique.Interventions: All patients received general anaesthesia, which was induced by propofol, remifentanil, and rocuronium. Anaesthesia was maintained using desflurane in oxygen air mixture in the inhalation group, whilst anaesthesia was maintained by intravenous infusion of propofol and dexmedetomidine in the TIVA group.Measurements: Intra-operative vital signs, anaesthesia recovery time, postoperative nausea and vomiting, pain score, post-anaesthetic care unit (PACU) stay time, total first 24 h post-operative analgesic needs and the onset of first bowel movement were recorded.Main resultsThe TIVA group had lower intra-operative heart rates and mean arterial blood pressure (P < 0.0001). The TIVA group also had a lower post-operative visual analogue score for pain assessment (VAS) (P < 0.0001), lower total analgesic requirements (P < 0.0001), a lower incidence of nausea (P = 0.01) and vomiting (P = 0.03), and shorter PACU stays (P = 0.01). There was no significant difference between groups with regard to the onset of bowel movement (P = 0.16).Conclusions: TIVA using propofol and dexmedetomidine is a better anaesthetic regimen than inhalation anaesthesia using desflurane for laparoscopic sleeve gastrectomy in morbidly obese patients. The TIVA technique provided better postoperative recovery with fewer postoperative side effects and analgesic requirements. (C) 2017 Elsevier Inc. All rights reserved.