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首页> 外文期刊>The Internet Journal of Anesthesiology >Comparative Effects Of Propofol Infusion Versus Sevoflurane For Maintenance Of Anesthesia For Spine Surgery
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Comparative Effects Of Propofol Infusion Versus Sevoflurane For Maintenance Of Anesthesia For Spine Surgery

机译：异丙酚输注与七氟醚维持脊柱手术麻醉的比较效果

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摘要

Thirty patients of ASA grade I and II posted for elective spine surgery in prone position under general anesthesia were selected for the study. The patients were randomly assigned into two groups, Sevoflurane (Group S, n=15) and Propofol (Group P, n=15).A standard premedication and induction regimen was followed in all cases. Group S patients received N2O / O2 / Sevoflurane / Vecuronium and Group P received N2O / O2 / Propofol infusion / Vecuronium for maintenance of anesthesia to a desired level. Recovery was assessed with a simulated wake up test and a simple behavioral score was employed to assesses the over all recovery. The observation revealed that maintenance of anesthesia with sevoflurane was associated with a faster recovery than propofol anesthesia. But in a pharmacoeconomic based approach the increased cost of sevoflurane has to be linked with the benefits of rapid emergence. Introduction In a hospital that is hard pressed to operate more number of cases per day, the technique of administering anesthesia should be modified in such a way that the patient can be extubated early and the operating room time for each patient can be minimized. In order to do so shorter acting intravenous anesthetics that can be administered in infusion form or inhalational agent with low blood solubility with faster induction and recovery have been tried by many anesthesiologist for maintenance of anesthesia(1,2).The brevity of action and rapid recovery with propofol has led to extensive usage of this agent for maintenance of anesthesia along with oxygen and nitrous oxide(3,4).Similarly the newly introduced volatile anesthetics to Indian scenario , Sevoflurane also allow faster recovery from anesthesia (2) because of its favorable pharmacokinetic properties. Although the clinical effects , recovery profile and the cost of administering propofol and sevoflurane have been measured separately in various outpatient operations but have not been evaluated in patients undergoing long surgical procedures like laminectomy(5). So the present study has been carried out to compare Sevoflurane with that of propofol infusion for maintaining anesthesia with respect t hemodynamic characteristics and recovery profile. Patients And Methods After ethical committee approval and patients informed consent the study was initiated in thirty adult patients of ASA physical status grade I and II scheduled for elective spinal surgery in prone position under general endotracheal anesthesia with controlled ventilation. The patients were randomly assigned into two groups of fifteen each depending on whether they received sevoflurane (Group S) or propofol infusion (Group P) for maintenance of anesthesia.A standard premedication regimen 9 tablet Diazepam5 mg oral; Inj Glycopyrolate 0.2mg intramuscular) was given to all patients one hour before surgery. In both groups patients were induced with Thiopentone 4-7 mg per Kg., midazolam 2.0 mg and Fentanyl 2mcg per kg.Vecuronium 0.1mg per Kg was given for muscle relaxation and was followed by tracheal intubation and intermittent positive pressure ventilation in a closed system using a circle absorber with a fresh gas flow of 2 litres per minute.In Group S , anesthesia was maintained with sevoflurane along with a mixture of O2:N2O :: 50:50 and supplemental vecuronium.In Group P , anesthesia was maintained by 1% propofol, 1mg per Kg bolos followed by continuous propofol infusion with a syringe pump along with O2:N2O :: 50:50 and vecuronium.The concentration of sevoflurane used and the rate of infusion of propofol were at the discretion of the anesthesiologist so as to maintain adequate depth of anesthesia (defined as a variation in heart rate and mean arterial pressure with in 10% of the base line value. Fentanyl 1mcg per kg was supplemented hourly. After completion of surgery the patient had been turned to supine position and once the patient show spontaneous breathing attempt anesthetic agent were stopped. Residual neuromuscul
机译：选择了30例在全身麻醉下俯卧位进行择期脊柱外科手术的ASA I级和II级ASA患者。将患者随机分为两组，七氟醚（S组，n = 15）和丙泊酚（P组，n = 15）。所有病例均遵循标准的处方和诱导方案。 S组患者接受N2O / O2 /七氟醚/维库溴铵治疗，P组患者接受N2O / O2 /异丙酚输液/维库溴铵治疗，以维持麻醉至所需水平。通过模拟唤醒测试评估恢复情况，并采用简单的行为评分来评估总体恢复情况。观察结果表明，与异丙酚麻醉相比，七氟醚维持麻醉的恢复速度更快。但是，在基于药物经济学的方法中，七氟醚的成本增加必须与快速出现的好处联系在一起。引言在每天需要处理更多病例的医院中，麻醉的技术应进行修改，以使患者可以尽早拔管，并可以将每个患者的手术室时间减至最少。为了做到这一点，许多麻醉医师尝试了以麻醉剂形式使用静脉输注形式或低溶血度的吸入型麻醉剂，以诱导和恢复更快的目的，以维持麻醉（1,2）。丙泊酚的回收已导致该剂与氧气和一氧化二氮一起广泛用于维持麻醉（3,4）。与印度新近引入的挥发性麻醉剂一样，七氟醚也因其麻醉性较快而得以恢复（2）。有利的药代动力学性质。尽管已在各种门诊手术中分别测量了临床效果，恢复情况以及丙泊酚和七氟醚的使用成本，但尚未对接受椎板切除术等长期手术的患者进行评估（5）。因此，本研究已经进行了比较，以比较七氟醚与异丙酚输注在维持血液动力学特征和恢复曲线方面的麻醉效果。患者和方法经伦理委员会批准并征得患者知情同意后，该研究开始于30例ASA身体状况为I和II级的成年患者，计划在全身气管内麻醉和控制通气的情况下进行俯卧位择期脊柱外科手术。根据患者是否接受七氟醚（S组）或异丙酚输注（P组）将其随机分为两组，每组15例，以维持麻醉。标准的处方药为9片地西p 5毫克口服;术前一小时向所有患者注射肌注甘油格列酮0.2mg。两组患者均被诱导使用噻磷酮4-7 mg / kg，咪达唑仑2.0mg和芬太尼2mcg / kg。维库溴铵0.1mg / kg用于肌肉松弛，然后气管插管和间歇性正压通气在封闭系统中进行在S组中，七氟醚与O2：N2O :: 50：50和补充维库溴铵的混合物维持麻醉状态;在S组中，麻醉维持1分钟。丙泊酚％，每千克液体1mg，然后用注射泵将丙泊酚以及O2：N2O :: 50：50和维库溴铵连续输注。七氟醚的浓度和丙泊酚的输注速率由麻醉医师决定，因此维持足够的麻醉深度（定义为心率和平均动脉压的变化，以基线值的10％为单位。每小时每公斤补充1mcg芬太尼。手术后患者d仰卧，一旦患者表现出自发呼吸尝试，便停止麻醉剂。残留神经肌肉

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