Randomized comparison of recovery after propofol-nitrous oxide versus thiopentone-isoflurane-nitrous oxide anaesthesia in patients undergoing ambulatory surgery

A randomized, prospective study was performed to compare recovery characteristics in 41 ASA physical status I-II patients scheduled for ambulatory surgery with either propofol or thiopentone-isoflurane anaesthesia. Particular attention was focused on the recovery time needed to meet discharge criteria. The propofol group received propofol 2 mg.kg-1 for induction followed by propofol infusion (6-9 mg.kg-1.h-1) 1 min after intubation. The thiopentone-isoflurane group received thiopentone 4 mg.kg-1 for induction followed by isoflurane (0.5-2%) 1 min after endotracheal intubation. Other drugs administered during or after anaesthesia were similar between the groups. The propofol group had significantly (P less than 0.05) faster clinical recovery than the isoflurane group with respect to times to response to commands, eye opening, orientation, ability to stand and void, tolerance to oral fluids, "home-readiness", and recovery of perceptual speed. Patients in the propofol group had significantly less (P less than or equal to 0.05) emesis than the patients given isoflurane. We conclude that in patients undergoing ambulatory surgery propofol infusion is preferable to thiopentone-isoflurane anaesthesia, because it may allow faster discharge home.     

A comparison of emergence delirium scales following general anesthesia in children

Background: Emergence delirium (ED) is of increasing interest since the introduction of short‐acting volatiles such as sevoflurane. Methods: We compared the Pediatric Anesthesia Emergence Delirium (PAED), Watcha and Cravero scales for assessing the presence of ED in 117 of 118 consecutive children <18 years recovering from general anesthesia. The primary measure was the worst score for ED as assessed on each scale and for each patient during their PACU stay. An experienced anesthetist observer also made a subjective assessment of the presence of ED. Results: A PAED score of ≥10 detected ED in 37 children (32%), while the Watcha detected 30 (26%) and Cravero 41 (35%). Twenty‐five patients (21%) fulfilled criteria for ED in all three scales as did all eight patients assessed by the experienced pediatric anesthetist observer. Median PAED scores (interquartile ranges) for patients assessed as having ED or not respectively were for Watcha, 12 (11,14), 7 (4,8); for Cravero, 11 (9,13), 7 (4,8); and for the experienced anesthetist observer, 14.5 (13.5,16.5), 7 (6,10). Conclusions: All three scales correlated reasonably well with each other but have individual limitations in their potential to assess whether ED is present. In the absence of developing an improved research tool to assess ED, a PAED score >12 appears to provide greater sensitivity and specificity than a PAED score ≥10. However, the Watcha scale is a simpler tool to use in clinical practice and may have a higher overall sensitivity and specificity than the other scales.     

丙泊酚复合雷米芬太尼或氧化亚氮用于妇科腹腔镜诊疗手术麻醉苏醒的比较

目的对丙泊酚复合雷米芬太尼或氧化亚氮用于妇科腹腔镜诊疗术后麻醉苏醒、早期拔管进行比较。方法选择ASAⅠ级,临床诊断不孕,拟于气管内插管的全麻下择期行腹腔镜检查及治疗的患者45例,随机分为三组:丙泊酚3μg/ml组(A组),丙泊酚2μg/ml组(B组)和氧化亚氮组(C组),每组15例。三组患者均为丙泊酚靶控输注(TCI)给药诱导及术中维持麻醉,罗库溴铵维持肌松。A组:维持丙泊酚靶浓度3μg/ml不变,雷米芬太尼根据血液动力学变化按0~1μg.kg-1.min-1输注给药,维持血液动力学稳定。B组:维持丙泊酚靶浓度2μg/ml不变,同样通过调整雷米芬太尼的给药速度维持血液动力学稳定。C组:丙泊酚TCI诱导,气管内插管后伍用氧化亚氮吸入维持麻醉。呼气末氧化亚氮浓度保持(65±1)%,通过调整丙泊酚的靶浓度来维持血液动力学稳定。三组患者均在手术结束时同时停麻醉药。以停麻醉的时间为零点计时,记录呼患者睁眼时间、气管拔管时间及答问切题时间。结果在睁眼时间、拔管时间和答问切题时间三项观察指标中,各组之间差异均有极显著意义(P<0.01)。B组患者睁眼时间(4.5±2.1)min、拔管时间(5.4±2.3)min、答问切题时间(8.1±2.8)min最短,说明麻醉苏醒最快;C组分别为(11.6±3.4)、(12.7±3.6)、(20.2±4.5)min,患者苏醒最慢;A组分别为(8.7±2.9)、(10.0±3.2)、(14.5±3.8)min,处于中间。结论低浓度丙泊酚TCI(2μg/ml)复合雷米芬太尼用于妇科腹腔镜诊疗手术,可使患者术后清醒快,恢复迅速。     

Vital capacity breath technique for rapid anaesthetic induction: comparison of sevoflurane and isoflurane

This study compares vital capacity rapid inhalational induction of anaesthesia with sevoflurane and isoflurane. Forty-six volunteers undergoing the procedure had one of the two agents: 25 had sevoflurane and 21 isoflurane. Subjects were unpremedicated and breathed approximately 1.7 MAC equivalents of either vapour. There were no significant differences in the patients' monitored cardiovascular, respiratory, and electrocardiographic variables. The mean time for induction of anaesthesia with sevoflurane (120 s) was significantly shorter than with isoflurane (145 s), reflecting its higher blood-gas solubility. There were fewer induction complications in the sevoflurane group. Subjects in the sevoflurane group found the induction of anaesthesia more pleasant and were more willing to undergo it again compared to subjects in the isoflurane group. We conclude that sevoflurane is superior to isoflurane in vital capacity rapid inhalational induction of anaesthesia, particularly in instances where premedication should be avoided.     

羟考酮在全身麻醉诱导中的临床应用

目的探讨羟考酮行全麻诱导的有效性与安全性。方法择期行结直肠癌手术患者60例,年龄35~75岁,随机分为两组,每组30例。F组静脉注射芬太尼2μg/kg、丙泊酚2mg/kg与顺式阿曲库铵0.15mg/kg行全麻诱导;O组静脉注射羟考酮0.2mg/kg、丙泊酚2mg/kg与顺式阿曲库铵0.15mg/kg行全麻诱导。记录诱导前(T0)、插管前1min(T1)、插管后即刻(T2)、插管后1min(T3)、5min(T4)的MAP和HR;记录手术时间、苏醒时间、拔管时间及不良反应情况。结果与T0时比较,T1时两组MAP均明显降低,T2时明显升高(P0.05),且T1时F组明显低于O组(P0.05);T1时F组HR明显减慢(P0.05);T2、T3时两组HR均明显增快(P0.05)。插管期间两组HR差异无统计学意义。两组手术时间、苏醒时间、拔管时间差异无统计学意义。F组咳嗽发生率明显高于O组(P0.05)。结论羟考酮可以安全有效地用于临床全身麻醉气管插管的诱导。     

The comparative effect of single dose mivacurium during sevoflurane or propofol anesthesia in children

BACKGROUND: We aimed to randomly compare intubating conditions, recovery characteristics and neuromuscular effects of single dose of mivacurium (0.2 mg.kg(-1)) during sevoflurane vs. propofol anesthesia in 60 healthy children, undergoing inguinal surgery. METHODS: All children were randomly allocated to receive 2 mg.kg(-1) propofol iv or sevoflurane 8% inspired concentration for induction of anesthesia. Anaesthesia was maintained with 66% nitrous oxide in oxygen and 100-120 microg.kg(-1) propofol or sevoflurane approximately 2-3% inspired concentration with controlled ventilation. The ulnar nerve was stimulated at the wrist by a train-of four (TOF) stimulus every 20 s and neuromuscular function was measured at the adductor pollicis. When the response to TOF was stable, 0.2 mg.kg(-1) mivacurium was given. The trachea was intubated successfully at the first attempt in all patients. RESULTS: Onset time following a single dose of mivacurium was shorter in the sevoflurane group (2.99 min), than in the propofol group (4.42 min). The times to 25, 50, 75, and 90% recovery were significantly longer in the sevoflurane group (13.1, 15.7, 18.6, and 21.2 min, respectively) than in the propofol group (11.4, 13.2, 14.4, and 17.2 min respectively). TOF ratios of 50, 70, and 90% were significantly occurred later in sevoflurane group than propofol group. CONCLUSIONS: Our results indicate that when compared with propofol group, the sevoflurane group had an accelerated onset and a delayed recovery of neuromuscular block induced by mivacurium in children.     

Sevoflurane: a comparison between vital capacity and tidal breathing techniques for the induction of anaesthesia and laryngeal mask airway placement

Sixty unpremedicated adult day-case patients were randomly assigned to either vital capacity or tidal breathing inhalational induction techniques. End points assessed included loss of eyelash reflex, time to drop a weighted syringe, time to jaw relaxation and time to the end of laryngeal mask airway insertion. Complications occurring during the induction of anaesthesia were recorded. The data show that there is no statistical or clinical difference between the two induction techniques. Patient acceptance of both techniques was similarly high. When the time taken to prime the anaesthetic breathing system is taken into consideration, the vital capacity technique is more expensive for induction of anaesthesia. These results therefore question the need for the vital capacity induction technique with sevoflurane 8%.     

Recovery characteristics of sevoflurane or halothane for day-case anaesthesia in children aged 1-3 years

BACKGROUND: Our objective was to compare the recovery characteristics of sevoflurane and halothane for short day-case anaesthesia in a specifically limited age group of children 1-3 yr. METHODS: Eighty unpremedicated children undergoing day-case adenoidectomy were randomly assigned to receive inhalational induction with either sevoflurane 8% or halothane 5% and nitrous oxide in oxygen (70/30) via a face mask. Tracheal intubation was performed without a muscle relaxant. Anaesthesia was continued with the volatile anaesthetic, adjusted to maintain heart rate and blood pressure within +/-20% of initial values. Recovery was evaluated using a modified Aldrete score, a Pain/Discomfort scale and by measuring recovery end-points. A postoperative questionnaire was used to determine the well-being of the child at home until 24 h after discharge. RESULTS: Emergence and interaction occurred significantly earlier after sevoflurane than halothane but discharge times were similar. More children in the sevoflurane group achieved full Aldrete scores within the first 30 min after anaesthesia, although this group suffered more discomfort during the first 10 min. The amount of postoperative analgesic administered was higher and the first dose given earlier in the sevoflurane group. Postoperative vomiting was more common with halothane, but side-effects in the two groups were otherwise similar in the recovery room and at home. CONCLUSIONS: In children 1-3 yr, sevoflurane provided more rapid early recovery but not discharge after anaesthesia of <30-min duration. Apart from more vomiting with halothane and more discomfort during the first 10 min after awakening with sevoflurane, the quality of recovery was similar with the two anaesthestics.     

A comparison between single- and double-breath vital capacity inhalation induction with 8% sevoflurane in children

BACKGROUND: This study was conducted to determine if a double-breath (DB) vital capacity (VC) rapid inhalation induction using immediate high-inspired concentration of sevoflurane is as well tolerated as a single-breath (SB) technique and if it results in a shorter induction time. METHODS: A total of 104 children, ASA I-II, 6 year and above, undergoing elective surgery were randomly assigned to two groups: SB VC inhalation induction or DB VC inhalation induction with 8% sevoflurane in 66% nitrous oxide. The induction time, complications (cough, laryngospasm, breath-hold, movement, salivation) and level of satisfaction were documented. RESULTS: Induction was significantly faster in the DB group (41 +/- 9 s) compared with the SB group (50 +/- 14 s). DB inhalation induction was associated with fewer complications (15.4%) than the SB technique (50%). CONCLUSIONS: Double-breath VC inhalation induction with 8% sevoflurane is as well tolerated as a SB technique and results in a faster onset of anaesthesia.     

Single-breath inhalation induction of sevoflurane anaesthesia with and without nitrous oxide: a feasibility study in adults and comparison with an intravenous bolus of propofol

The induction characteristics of sevoflurane in nitrous oxide and oxygen were compared with sevoflurane in oxygen alone and a propofol infusion. A vital capacity technique was used for the gaseous induction groups using a Mapleson A system and a 4-litre reservoir bag. Four end-points of anaesthesia were recorded: time to cessation of finger tapping, time to loss of eyelash reflex, time to jaw relaxation and time to regular settled breathing after laryngeal mask airway insertion. We also recorded sequential blood pressure and pulse rate, the incidence of adverse airway events and the acceptability of the induction technique. Propofol had a faster time to cessation of finger tapping (p <0.05) and jaw relaxation (p <0.01). These differences disappeared with the final induction stage and sevoflurane in nitrous oxide and oxygen had the faster time to regular settled breathing, though this did not reach statistical significance. Cardiovascular stability was good and comparable in all groups. There were few adverse airway events in any group and none caused oxygen saturation to fall below 96%. There was more excitation in the gaseous induction groups, though this did not interfere with induction. Patient satisfaction with induction was high.     

Stress hormone changes in general anesthesia of long duration: isoflurane-nitrous oxide vs sevoflurane-nitrous oxide anesthesia

STUDY OBJECTIVE: There are few comparative studies of stress hormone changes during general anesthesia with long duration between isoflurane-nitrous oxide and sevoflurane-nitrous oxide anesthesia. We investigated perioperative changes of stress hormone in these two anesthetic methods with duration of more than 10 hours. DESIGN: Prospective study. SETTING: Operating room and high care unit of a university hospital. PATIENTS: Twenty patients with ASA physical status I or II for surgery for laryngeal or pharyngeal cancer with expected duration of more than 10 hours. INTERVENTIONS: Anesthesia was induced with midazolam, thiopental, and vecuronium and was maintained with sevoflurane (sevoflurane group) or isoflurane (isoflurane group) with nitrous oxide 4 L/min in oxygen 2 L/min. MEASUREMENTS AND MAIN RESULTS: Plasma concentrations of epinephrine, norepinephrine, cortisol, adrenocorticotropic hormone, and anti-diuretic hormone (ADH); serum concentrations of glucagon and insulin; and blood glucose concentration were measured before inhalation of anesthetics, after 5 and 10 hours, and at 1, 6, and 12 hours after the end of inhalation. Epinephrine and norepinephrine concentrations increased continuously during and after surgery in the isoflurane group whereas it increased only after surgery in the sevoflurane group. Both concentrations were higher in the isoflurane group during anesthesia. Cortisol increased continuously whereas adrenocorticotropic hormone increased only during surgery. Anti-diuretic hormone increased with its peak during surgery and the isoflurane group had significantly higher values than the sevoflurane group. Glucose increased both during and after surgery, insulin increased only after surgery, and glucagon decreased during surgery in both groups. CONCLUSIONS: In inhalation anesthesia with the duration of more than 10 hours, isoflurane-nitrous oxide and sevoflurane-nitrous oxide had the same effects on stress hormone changes except for epinephrine, norepinephrine, and ADH. Epinephrine, norepinephrine, and ADH concentrations were higher in isoflurane-nitrous oxide anesthesia.     

A review of recovery from sevoflurane anaesthesia: comparisons with isoflurane and propofol including meta-analysis

BACKGROUND: Sevoflurane has a lower blood:gas partition coefficient than isoflurane and thus should be associated with a more rapid recovery from anaesthesia. METHODS: A review and meta-analysis were employed to examine the recovery profiles of adult patients following anaesthesia, comparing sevoflurane to isoflurane and sevoflurane to propofol. RESULTS: There were significant differences in times to several recovery events that favoured sevoflurane to isoflurane anaesthesia, including time to emergence, response to commands, extubation, and orientation. Likewise, there were significant differences in times to the same recovery events following anaesthesia with sevoflurane versus propofol. There were no differences in time to recovery room discharge when comparing sevoflurane to isoflurane or propofol. CONCLUSION: The observed differences between sevoflurane and isoflurane or propofol anaesthesia support the postulate that the use of sevoflurane is associated with a more rapid recovery from anaesthesia than either isoflurane or propofol.     

右美托咪定对老年患者全麻诱导过程中心率变异性的影响

目的探讨右美托咪定对老年患者全麻诱导过程中心率变异性(HRV)的影响。方法选择全麻老年患者50例,随机均分为两组:D组麻醉诱导前给予右美托咪定负荷量0.5μg/kg稀释至20ml泵注,10min输注完毕,再以0.3μg·kg-1·h-1泵注至插管后5min。C组静脉泵注等量生理盐水。记录入室后(T0)、右美托咪定负荷量结束后(T1)、气管插管前(T2)及插管后1min(T3)、3min(T4)、5min(T5)时HRV指标:总频(TP)、低频(LF)、高频(HF)及低频/高频(LF/HF)。结果与T1时比较,D组T3～T5时LF,T4、T5时HF,T5时TP明显升高(P0.05);T3～T5时LF/HF明显降低(P0.05)。与C组比较,T3～T5时D组LF,T2～T5的HF和TP明显升高(P0.05),T1～T5时D组LF/HF明显降低(P0.05)。结论全麻诱导过程中给予右美托咪定能够升高HRV,可以有效地调节交感-迷走神经张力的均衡性,稳定心血管功能。     

Anaesthetic induction time for tracheal intubation using sevoflurane or halothane in children

The current study was designed to determine the anaesthetic induction time required for tracheal intubation (Time_EI) with equipotent inspired concentrations of 5% sevoflurane and 2.5% halothane in oxygen. Time_EI that prevents 50% and 95% of patients from coughing and gross purposeful muscular movements after intubation was defined as Time_EI50 and Time_EI95, respectively. Thirty-six patients aged 1–7 years were enrolled in the study. Anaesthesia was induced via mask and when Time_EI attained a predetermined value, intubation was performed using an uncuffed tube. Each Time_EI at which tracheal intubation was attempted was predetermined according to the up-and-down method. When intubation was accomplished without gross purposeful muscular movements, it was considered a smooth intubation. Determination with this method revealed that Time_EI50 and Time_EI95 for the sevoflurane/halothane groups were 147/214 s and 194/255 s, respectively. In conclusion, it is possible to determine Time_EI using an inspired sevoflurane concentration of 5% and halothane 2.5% in oxygen. The technique with 5% sevoflurane seems more practical for paediatric anaesthesia induction in busy clinical situations.     

Quality of recovery from two types of general anesthesia for ambulatory dental surgery in children: a double-blind, randomized trial

Background:  Pediatric dental procedures are increasingly performed under general anesthesia because of the inability to cooperate, situational anxiety, or other behavioral problems. Volatile anesthetics have been associated with emergence delirium in children, whereas the use of propofol for anesthetic maintenance has been shown to reduce the incidence of emergence delirium after other types of surgeries. The aim of this study is to compare a sevoflurane-based anesthetic with a propofol-based technique as it relates to the incidence of emergence delirium and the quality of recovery after pediatric dental surgery, in patients who present with risk factors for perioperative behavioral issues.
Methods:  We prospectively collected data of 179 pediatric patients scheduled for ambulatory dental surgery using a double-blind and randomized trial design. Subjects were anesthetized following standardized protocols for either a sevoflurane- or a propofol-based technique. The incidence of emergency delirium, as measured by the Pediatric Anesthesia Emergence Delirium score, was the primary outcome. Secondary outcomes included the incidence of postoperative nausea and vomiting (PONV), number of nursing interventions in the recovery room, time to discharge readiness, and parental satisfaction.
Results:  We found no difference in the incidence of emergence delirium after both types of anesthesia. However, use of sevoflurane significantly increased both the risk of PONV and the number of postoperative nursing interventions. Discharge criteria were met about 10 min earlier in patients anesthetized with sevoflurane. Parental satisfaction was equally high with both anesthesia regimens.
Conclusions:  A propofol-based anesthetic technique did not lead to a lower incidence of emergence delirium after dental surgery in children but did result in significantly less PONV and fewer postoperative nursing interventions.     

Clinical office anesthesia: The use of propofol for the induction and maintenance of general anesthesia

Ambulatory surgery has become routine for many plastic surgery procedures. Anesthesia techniques including general anesthesia by inhalation and intravenous infusion and the dissociative technique have all been used successfully for outpatient anesthesia. Propofol (Diprivan), a relatively new agent, has proven to be a safe and effective general anesthesia agent for outpatient surgery. We report on our experience with propofol as an induction agent and continuous drip for general anesthesia maintenance in 100 consecutive outpatient, plastic surgery procedures performed in an office facility. Assessment factors were recovery-room time, nausea and vomiting in the recovery room and at home, hallucinations, patients' recollection of anesthesia experience, and overall patient satisfaction.     

右美托咪定与哌替啶预防全麻患者术后寒战效果的比较

目的 比较右美托咪定与哌替啶预防全麻患者术后寒战的效果.方法 择期行腹腔镜胆囊切除术患者60例,年龄18 ～ 75岁,体重40 ～ 85 kg,性别不限,ASA分级Ⅰ～Ⅲ级.按年龄进行分层,采用分层随机法,将患者随机分为2组(n=30)∶哌替啶组(P组)和右美托咪定组(D组).停止气腹时P组和D组分别经10 min静脉输注哌替啶0.5 mg/kg和右美托咪定1 μg/kg.记录术后1h内寒战、呼吸抑制、嗜睡、恶心呕吐、心动过缓和低血压的发生情况.结果 与P组比较,D组寒战发生率及程度差异无统计学意义(P＞ 0.05),呼吸抑制及恶心呕吐发生率降低,心动过缓发生率升高(P＜0.05).结论 右美托咪定预防全麻患者术后寒战发生的效果优于哌替啶.