Choice of volatile anesthetic for the morbidly obese patient: sevoflurane or desflurane
Choice of volatile anesthetic for the morbidly obese patient: sevoflurane or desflurane
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DOI：
10.1016/j.jclinane.2004.12.015
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发表时间：
2005-09-01
影响因子：
6.7
通讯作者：
Ebert, TJ
中科院分区：
文献类型：
--
作者：
Arain, SR;Barth, CD;Ebert, TJ
研究目的：病态肥胖与显著的合并症相关。地氟醚脂血溶解度系数低，可能更适合在这类人群中实现快速涌现；然而，七氟醚具有良好的心肺特性，可能对病态肥胖（MO）患者也有好处。本研究通过仔细的药物滴定来确定是否可以最小化七氟醚和地氟醚在MO患者中的出现差异。设计：一项随机、前瞻性盲法研究，以确定在使用麻醉药物滴定时，地氟醚和七氟醚在MO患者中的出现情况。地点：威斯康星州密尔沃基市退伍军人医疗中心手术室。患者：选取40例美国麻醉医师学会II级和III级MO患者（体重指数>= 35 kg/m(2)），预计择期手术时间超过2小时。干预措施：芬太尼、咪达唑仑和异丙酚诱导，地氟醚或七氟醚维持，空气和氧气混合。术中双谱指数（BIS）目标为45 ~ 50，手术最后15分钟目标为60。测量：记录术中麻醉浓度、BIS、血流动力学。在急救过程中，记录了遵循指令和拔管的时间，并通过迷你精神状态测试评估了认知功能，通过数字符号替代测试评估了精神运动表现。一个不知情的观察者记录了关键恢复事件。主要结果：人口学资料（年龄61[36-83]岁，体重指数38 [35-47]kg/m(2)）、手术方式、麻醉时间（约3.5小时）、辅助用药、术中BIS、心率、平均动脉压无显著差异。血流动力学、指令执行时间、拔管时间、手指符号替代测试和精神状态测试结果在麻醉组间无显著差异。结论：仔细滴定麻醉浓度时，接受地氟醚或七氟醚治疗的MO患者的出现和恢复情况无差异。(c) 2005爱思唯尔公司版权所有。
Study Objective: Morbid obesity is associated with significant comorbidities. Desflurane has a low fat-blood solubility coefficient and may be better suited in this population to achieve a rapid emergence; however, sevoflurane has favorable cardiorespiratory properties that might also prove advantageous in the morbidly obese (MO) patient. This study used careful drug titration to determine if emergence differences between sevoflurane and desflurane could be minimized in MO patients.Design: A randomized, prospective blinded study to determine the emergence profiles of desflurane and sevoflurane in MO patients when anesthetic drug titration is used. Setting: Operating room of the VA Medical Center, Milwaukee, Wis.Patients: Forty American Society of Anesthesiologists II and III, MO patients (body mass index >= 35 kg/m(2)), who were scheduled for elective surgery predicted to last for more than 2 hours, were studied. Interventions: Patients were induced with fentanyl, midazolam, and propofol and maintained with desflurane or sevoflurane, mixed in air and oxygen. Intraoperative bispectral index (BIS) was targeted to 45 to 50 and to 60 in the last 15 minutes of surgery.Measurements: Intraoperative anesthetic concentration, BIS, and hemodynamics were recorded. During emergence, time to follow command and extubation were noted, with assessments of cognitive function via the Mini-Mental Status Test and psychomotor performance via the Digit Symbol Substitution Test. A blinded observer recorded key recovery events.Main Results: Demographic data (age, 61 [36-83] years; body mass index, 38 [35-47] kg/m(2)), surgical procedures, length of anesthesia (similar to 3.5 hours), adjuvant drugs, and intraoperative BIS, heart rate, and mean arterial pressure were not significantly different. Hemodynamics, time to follow commands and to E extubation, and results of Digit Symbol Substitution Test and Mini-Mental Status Test did not differ between anesthetic groups during recovery.Conclusions: There were no differences in emergence and recovery profiles in MO patients receiving desflurane or sevoflurane when anesthetic concentration was carefully titrated. (c) 2005 Elsevier Inc. All rights reserved.