异丙酚和地氟烷用于动脉瘤性SAH手术后患者术后并发症的比较：随机临床试验
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Comparison of propofol and desflurane for postanaesthetic morbidity in patients undergoing surgery for aneurysmal SAH: a randomized clinical trial
背景
蛛网膜下腔出血（SAH）后动脉瘤夹闭给麻醉麻醉带来了独特的挑战。 然而，缺乏麻醉药物对这些患者影响的数据。本研究旨在评估异丙酚和地氟烷用于动脉瘤性SAH手术后患者的术后并发症的比较。
方 法
70个WFNS分级I和II级患者被随机分为异丙酚（n = 35）和地氟醚组（n = 35）。异丙酚接受异丙酚和芬太尼麻醉；地氟醚组接受地氟醚和芬太尼麻醉； 在术中评估颈静脉血氧饱和度（SjVO2）和脑松弛度。 从停止使用麻醉剂时开始注意到睁眼、遵从口头命令的反应和拔管的时间。 随后比较术后住院时间和改良Rankin评分（MRS）。
结 果
术后住院时间中位中位数，异丙酚组为9天，地氟醚组为9天。预后良好（改良Rankin评分0-1）的患者:丙泊酚组18例，地氟烷组14例。 两种麻醉剂在术中血流动力学，脑松弛，睁眼时间，遵从口头指令的反应和拔管时间方面均相似（P> 0.05）。 地氟烷组出现高血压的比例更高（P = 0.007）。 地氟烷组术中SjVO2值明显更高（P <0.05）。
结 论
在SAH后进行动脉瘤颈缩的患者中，异丙酚和地氟醚的术后并发症相当。
原始文献摘要
PURPOSE:
Surgery for aneurysmal clipping after subarachnoid haemorrhage (SAH) poses a unique anaesthetic challenge. However, data on the influence of anaesthetic agents in these patients are lacking. The study aims to evaluate the superiority of propofol overdesflurane for postanaesthetic morbidity in patients undergoing surgery following aneurysmal SAH.
METHODS:
Seventy World Federation of Neurosurgeons Grade I and II patients were randomized into propofol (n = 35) anddesflurane groups (n = 35). Anaesthesia was maintained with propofol/fentanyl in propofol group and desflurane/fentanyl in thedesflurane group. Jugular venous oxygen saturation (SjVO2) and brain relaxation were assessed intraoperatively. Time to eye opening, response to verbal commands, and extubation were noted from the time of discontinuing the anaesthetic agent. Duration of postoperative hospital stay and modified Rankin score (MRS) at discharge were subsequently compared.
RESULTS:
Median postoperative hospital stay was 9 (6, 14) days with use of propofol and 9 (7, 12) days in desflurane group (P = 0.671). 18 patients in the propofol group and 14 patients in the desflurane group had good outcome (modified Rankin score 0-1; P = 0.453). Both the anaesthetics were similar in terms of intraoperative haemodynamics, brain relaxation, time to eye opening, response to verbal commands, and extubation time (P > 0.05). Emergence hypertension was more in the desflurane group (P = 0.007). The intraoperative SjVO2 values were significantly higher in the desflurane group (P < 0.05).
CONCLUSION:
Propofol and desflurane are comparable in terms of postoperative morbidity in patients undergoing aneurysm neck clipping following SAH.
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