使用麻醉氣體Sevoflurane對門診手術病人自主神經恢復的影響

Rapid Recovery of Spontaneous Baroreflex after Sevoflurane Anesthesia in Ambulatory Surgery

背景：Sevoflurane具備作用快，甦醒快，代謝快且不影響心血管及呼吸系統等特性。本實驗目的在評估sevoflurane用於門診手術麻醉後自主感壓反射恢復的情形。方法：記錄10位麻醉體位評議為壹級且接受常規門診婦科子宮內膜刮除術的病人之動脈壓訊號和心跳R-R interval，利用序列分析(sequence analysis)計算自主感壓反射敏感度(spontaneous baroreflex sensitivity, SBR)，比較術前、術中、術後5分鐘及術後10分鐘所得到之SBR值之差異。結果：術中(12.2 ± 2.1 ms/mmHg)及術後5 分鐘(15.8 ± 1.8 ms/mmHg)和術前(28.6 ± 4.9ms/mmHg)有明顯差異。術後10分鐘(28.8 ± 5.7 ms/mmHg)和術前則無明顯差異。結論：使用麻醉氣體sevoflurane對門診手術病人之自主神經系統的影響，於關麻藥後10分鐘內即恢復術前清醒時之感壓反射強度。

Background: Although sevoflurane seems to have fulfilled the criteria of ideal anesthetic agent for ambulatory surgery, its effects on intraoperative alteration and postoperative recovery of arterial baroreflex have not been well documented. This study assessed the time required for patients anesthetized with sevoflurane to regain their baseline baroreflex after ambulatory surgeries. Methods: Ten ASA class I female patients scheduled for minor gynecological operation (D&C) were enrolled in this study. Spontaneous baroreflex sensitivity (SBR) calculated by sequence analysis of beat-to-beat variations in systolic arterial pressure and R-R intervals was recorded before anesthesia (Baseline), during anesthesia (Anesthesia), five min after operation (Post-op 1) and ten min after operation (Post-op 2). Data obtained from Anesthesia, Post-op 1, and Post-op 2 was compared with the Baseline. Results: SBR value determined in Baseline group (28.6 ± 4.9 ms/mmHg) was significantly different from Anesthesia group (12.2 ± 2.1 ms/mmHg) and Post-op 1 group (15.8 ± 1.8 ms/mmHg). Patients regained their conscious baseline baroreflex sensitivity within ten min after sevoflurane was switched off. Conclusions: Sevoflurane anesthesia depresses SBR and provides a quick SBR recovery upon emergence.