七氟烷可替代丙泊酚用于成人麻醉诱导放置喉罩通气道

Sevoflurane Provides A Valuable Alternative to Propofol in Anesthesia Induction for Laryngeal Mask Airway Insertion in Adults

目的:比较七氟烷吸入诱导和丙泊酚静脉诱导用于插入喉罩通气道(LMA)的临床效能和安全性。方法:将80例ASAⅠ～Ⅱ级择期行下肢骨科手术患者随机分为2组。P组麻醉诱导采用静脉靶控输注丙泊酚,效应室浓度6mg/L;S组以肺活量法吸入七氟烷,目标呼气末浓度为4%。通过开口试验判断插入LMA适宜时机。观察麻醉诱导和放置LMA的过程,记录期间患者血流动力学的变化和不良反应的发生。结果:2种诱导方法都可以保证超过95%的患者一次顺利完成LMA的放置。S组患者意识消失时间较P组延长,但2组患者适宜LMA插入的麻醉诱导时间差异无统计学意义。P组患者诱导后平均动脉压(MAP)明显下降,S组患者试验期间血流动力学状态稳定,而且插入LMA后呼吸暂停的发生也明显低于P组(P<0.05)。结论:七氟烷吸入诱导可替代丙泊酚静脉诱导用于成年患者放置LMA。

Objective：To compare the clinical efficacy and safety of anesthesia induction between inhalation of sevoflurane and intravenous injection of propofol for laryngeal mask airway （LMA） insertion in adults. Methods：Eighty patients,ASA physical grade I-II,scheduled for elective orthopedic surgery involving lower extremities were allocated to 2 groups at random. Patients in group P received intravenous induction of propofol infusion by a target-controlled infusion system,which was set at the effect-site concentration of 6.0 mg/L. Patients in group S received inhalation induction with sevoflurane using vital capacity manoeuver at the target of end-expiratory concentration of 4.0%. The whole procedure of anesthesia induction and LMA insertion were observed. The changes in hemodynamic state and occurrence of adverse events were recorded. Results：More than 95% patients achieved LMA insertion at first attempt using either induction manoeuver. Although the time of consciousness loss was 21s longer in group S than that of group P,there was no difference in anesthesia induction time for LMA insertion between the two groups. Contrary to a significant decrease in mean arterial pressure following induction in patients of group P,the patients remained hemodynamically stable in group S. The occurrence of apnea was also significantly seldom in group S as compared to that of group P （15% vs 72.5%,P〈 0.05）. Conclusion：As compared to intravenous induction with propofol,inhalation induction with sevoflurane provides a valuable alternative for LMA insertion in adults.