使用Sevoflurane或Propofol於女性婦產科門診手術病人喉罩麻醉誘導之比較

Comparison of the Anesthesia Profiles between Sevoflurane-Nitrous Oxide and Propofol-Nitrous Oxide Conveyed by Laryngeal Mask Airway in Patients Undergoing Ambulatory Gynecological Surgery

背景：喉罩在日常麻醉越來越顯重要，我們想要比較使用吸入性麻醉劑sevoflurane合併笑氣和靜脈麻醉劑propofol合併笑氣在喉罩麻醉時，兩種不同麻醉方法下的臨床應用及特徵。方法：將80個接受門診婦科手術的病人隨機的分成兩組：（一）sevoflurane組：病人使用8％ sevoflurane合併67％笑氣誘導麻醉；（二）propopol組：病人以propofol 2 mg/kg靜脈注射及6 mg/kg/hr靜脈滴注誘導。當睫毛反射消失時，每隔15秒，檢查病人下顎是否足夠鬆弛，以進行喉罩插管。喉罩置入成功之後，sevoflurane組以2～3％sevoflurane維持麻醉，propofol組繼續靜脈給予 propofol 6 mg/kg/hr，兩組病人都併用67％的笑氣。結果：本實驗中propofol組比sevoflurane組，放置喉罩的時機快了59秒，而使用sevoflurane誘導，發生咳嗽及術後發生噁心，嘔吐的機率較高。在誘導時血液動力學，麻醉甦醒時隨指示張開眼睛，及恢復定向力的時間方面，兩組並無顯著的差別。結論：結果顯示，在誘導時，使用sevoflurane除了自主呼吸的機率較高之外，使用propofol作為麻醉誘導有較好的麻醉特性。

Background: The major purpose of this study is to evaluate and compare the clinical characteristics of sevoflurane-nitrous oxide and propofol-nitrous oxide anesthesias conveyed by laryngeal mask airway (LMA) in patients for gynecological procedures. Methods: Eighty female patients were randomly assigned to one of the two groups: Group I, inhalational induction at vital capacity with 8% sevoflurane and 67% nitrous oxide in oxygen; Group II, induction with intravenous propofol at 2 mg/kg followed by intravenous infusion at 6 mg/kg/hr. The LMA was inserted after loss of response to jaw thrusting. After successful insertion, in group I anesthesia was maintained with sevoflurane and 67% nitrous oxide in O2 and in group II anesthesia was maintained with propofol at 6 mg/kg/hr and nitrous oxide 67% in oxygen. Anesthetic profiles, including insertion event, postoperative nausea and vomiting, and hemodynamic alterations were compared. Results: Demographic data were comparable in the two groups. After induction, in group II unconsciousness was produced 59 sec shorter than that in group I for placement of LMA. Group I had a higher statistically significant rate of cough upon induction, and by the same token postoperative nausea and vomiting. There were no significant differences in hemodynamic alterations, as well as time to open eyes on command, and time to regain orientation. Conclusions: Intravenous propofol in combination with 67% nitrous oxide in oxygen technique provided better clinical profiles, compared with sevoflurane-nitrous oxide technique through the use of LMA in gynecological patients undergoing ambulatory short procedures.