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頁籤選單縮合
題名 | Earlier Cessation of Desflurane Supply in Closed-circuit Anesthesia Reduces Emergence Time in Patients Undergoing Breast Surgery=在閉鎖環境下提前終止Desflurane供應可縮短麻醉甦醒時間 |
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作 者 | 蕭介民; 陳威豪; 楊雅玲; 蘇浩博; 吳俞樺; 曾稼志; | 書刊名 | 麻醉學雜誌 |
卷期 | 45:1 2007.03[民96.03] |
頁次 | 頁21-26 |
分類號 | 416.5 |
關鍵詞 | 閉鎖循環麻醉; 吸入性麻醉劑; 麻醉恢復期; 甦醒; Desflurane; Anesthesia, closed-circuit; Anesthetics, inhalation; Anesthesia recovery period; Emergence; |
語文 | 英文(English) |
中文摘要 | 背景:本研究擬測定在主要手術完成後,提早終止desflurane供應,對麻醉甦醒時間之影響;其次,量化分析在閉鎖循環麻醉下,提早關閉desflurane供應,對氣道中desflurane藥物動力學變化及其對血循環動力學參數之影響。方法:本研究共蒐集30位需全身麻醉進行乳房手術之患者,隨機分成兩組,每組15人。所有患者均以相同方法進行麻醉誘導及維持,其中控制組供應desflurane至手術完成,而研究組則在完成主要手術後,開始縫皮膚時提早終止供應desflurane。所有患者均依麻醉需要記錄全程之生理參數,甦醒時間則定義為高流量開始至患者清醒能照指令張開眼睛之時間;研究組並在關閉desflurane供應後開始每分鐘紀錄心跳、血壓及呼出、吸入麻醉氣體濃度,以待事後分析。結果:在閉鎖循環麻醉下,在主要手術完成後,提早關閉Desflurane供應,確可縮短平均甦醒時間達3.2分鐘(5.6±1.9分比8.8±2.3分)。在閉鎖循環麻醉下提早關閉desflurane供應,吐出端之desflurane濃度改變極為緩慢(0.35%在前5分鐘;0.21%在6~10分;0.14%在11~15分)。其中吸入及呼出之濃度又於終止供應後7.1分交叉。血壓心跳不高過麻醉維持時期,亦低於進入開刀房之基本數值。結論:在主要手術結束後,皮膚縫合時提早關閉desflurane供應,確可縮短甦醒時間;且在閉鎖循環麻醉下提早關閉desflurane供應,呼出麻醉氣體濃度改變極為緩慢,血壓心跳亦不會高過麻醉維持時期及術前之基本值。 |
英文摘要 | Background: Minimizing the time of anesthesia emergence can facilitate faster patient turnover in the operating rooms of a busy surgery center. According to Lin's new concept of inhalation uptake, after turning off the vaporizer under close-circuit anesthesia (CCA) with a very low fresh gas flow rate, the concentration of desflurane decreases at a slow rate. The aim of this study was to determine if earlier cessation of desflurane supply would shorten the emergence time and at the same time register the changes of desflurane concentration in the circuit after turning off the vaporizer. Methods: 30 patients were randomly assigned to two groups, i.e., the control group and the study group. In the control group, the desflurane supply was continued up till the end of the operation, while in the study group the desflurane supply was cut off prior to the suturing the skin. In the study group, data regarding the hemodynamic changes, time from turning off desflurane with high flow washout to wakefulness, and the inspired as well as the expired desflurane concentrations at the low-flow anesthetic phase were collected. The time required from high flow washout to emergence was recorded in all patients. Inter-group and intra-group data were analyzed with nonparametric 2-independent-samples Mann-Whitney test and 2 related-samples Wilcoxon signed ranks test, respectively. Results: Under CCA with similar surgical duration, the patients in the study group emerged from anesthesia significantly faster than those in the control group (5.6 ± 1.9min versus 8.8 ± 2.3 min; P<0.05), withoutmolestation of stable hemodynamic signs. At the low-flow wash-in stage, the inspired desflurane concentrations were significantly higher than the expired ones from 0 to 2nd min; no significant difference was noted from the 3rd to 6th min, but after which the expired concentrations were significantly higher. Desflurane concentrations decreased most noticeably during the first 5 min (0.35 ± 0.14%), and then the decrease was moderating from 6th to 10th min (0.21 ± 0.58%) and staggered from 11th to 15th (0.14 ± 0.06%). The mean duration of low flow wash was 25.6 ± 11.6 min. No patient reported awareness during surgery. Conclusions: Ceasing desflurane supply earlier in CCA (250 mL/min) significantly shortens emergence time without significant hemodynamic changes. |
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