與七氟烷麻醉相比，地氟醚麻醉使接受甲狀腺手術的成年患者更易出現躁動

Desflurane anesthesia worsens emergence agitation in adult patients undergoing thyroid surgery compared to sevoflurane anesthesia.

背景與目的

揮發性麻醉藥對成人出現躁動的影響尚不清楚。 我們比較了在接受甲狀腺手術的成人中使用地氟醚和七氟醚麻醉出現興奮的程度。

方 法

將116位ASA分級1或2級的患者隨機分為兩組：地氟烷組（D組）和七氟醚組（S組）。用芬太尼（1-2μg/ kg）和丙泊酚（1.5-2.5mg / kg）誘導麻醉後，用琥珀膽鹼（0.5-1.0mg / kg）保證氣管插管。D組維持地氟烷在%66的笑氣及33%的氧氣中，必要時補充芬太尼。在S組中，使用七氟醚代替地氟醚。手術結束後拔管前使用改良的麻醉誘導譫妄評分（範圍從0至16，分數越高表示出現更嚴重的出現躁動）評估出現的興奮程度。評估手術結束至拔管的時間、術後疼痛（通過數字評分量表[NRS評估]）和手術後噁心嘔吐（PONV）

結 果

D組出現興奮程度比S組嚴重（中位數[四分位間距]：5 [4-7] vs 4 [2-6]，p = 0.008）。拔管時間、兩組lNRS評分和PONV發生率相似。

結 論

接受甲狀腺手術的成年患者與地氟醚麻醉相比，地氟醚麻醉加劇了出現躁動，但並未影響拔管時間，術後疼痛或PONV。

原始文獻摘要

Suzuki T, Kurazumi T, Ueda T, et al. Desflurane anesthesia worsens emergence agitation in adult patients undergoing thyroid surgery compared to sevoflurane anesthesia[J]. Ja Clinical Reports, 2017, 3(1):36.

BACKGROUND:

The effect of volatile anesthetics on emergence agitation in adults remains unclear. We compared the degree of emergence agitation between desflurane and sevoflurane anesthesia in adults undergoing thyroid surgery.

FINDINGS:

One hundred and sixteen patients with American Society of Anesthesiologists status 1 or 2 were randomized into two groups: the desflurane group (group D) and the sevoflurane group (group S). After induction of anesthesia with fentanyl (1-2 μg/kg) and propofol (1.5-2.5 mg/kg), tracheal intubation was facilitated with suxamethonium (0.5-1.0 mg/kg). In group D, anesthesia was maintained with desflurane in 66% nitrous oxide and 33% oxygen supplemented with fentanyl when necessary; in group S, sevoflurane was used instead of desflurane. After the end of the surgery, emergence agitation was evaluated with a modified pediatric anesthesia emergence delirium scale (ranging from 0 to 16, with higher scores indicating more severe emergence agitation) before extubation. Time to extubation from the end of the surgery, postoperative pain (evaluated by a numerical rating scale [NRS]), and postoperative nausea and vomiting (PONV) after surgery were examined.

RESULTS:

The degree of emergence agitation was more severe in group D than in group S (median [interquartile range]: 5 [4-7] vs 4 [2-6],p?=?0.008). Time to extubation, NRS scores, and PONV rates were similar between the two groups.

CONCLUSIONS:

Desflurane anesthesia worsened emergence agitation as compared with sevoflurane in adult patients undergoing thyroid surgery, but did not affect time to extubation, postoperative pain, or PONV.

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