低劑量Fentanyl及Propofol可以改善成人麻醉使用Sevoflurane進行潮氣呼吸誘導法的誘導速度及品質

Low Dose Fentanyl and Propofol Improve the Speed and Quality of Tidal-Breathing Induction Techniques in Sevoflurane Anesthesia for Adults

背景：本研究是觀察利用高濃度sevoflurane進行潮氣呼吸誘導法後，使用喉罩維持麻醉的成年患者，於即將進行麻醉誘導前，靜脈給予低劑量fentanyl或再合併給予低劑量propofol，對於誘導速度及品質是否有改善效果。方法：一百二十名病人隨機分為三組。S組：使用8％ sevoflurane進行麻醉誘導；F+S組：麻醉誘導前靜脈給予fentanyl 1 μg/kg ； F+P+S組：麻醉誘導前靜脈給予fentanyl 1 μg/kg及propofol 0.5 mg/kg。結果：本研究顯示自開始誘導至眼睫反射消失時間(P < 0.05，Group F+P+S vs. F+S；P < 0.01，Group F+P+S vs. S)，下頷關節鬆弛時間(P < 0.05，Group F+P+S vs. S)，及喉罩置入時間(P < 0.01，Group F+P+S vs. S)，F+P+S組所需時間比較短，併發症（如咳嗽，不自主動作）的發生率也較低，至於喉罩第一次置入成功率則三組間沒有差別。根據術後的意見調查，F+P+S組有57.5％的病人認為誘導過程舒適(P<0.05)，75％的病人將來仍會選擇同樣的麻醉方式(P<0.05)，並且有統計上的差異。此結果可能是因為該組使用藥物的輕度鎮靜作用，以及由於較短的誘導時間而 有意義的減少了因麻醉氣體所引起的不愉快回憶。結論：使用8％sevoflurane進行潮氣呼吸誘導法，並利用喉罩維持麻醉的成人患者(ASA I-II)，於即將誘導前給予fentanyl 1 μg/kg及propofol 0.5 mg/kg，可以提供一個比僅給予fentanyl 1 μg/kg或不給予誘導前藥物，比較短而舒適的誘導過程。

Background: The objective of this study was to investigate whether low dose fentanyl, with or without low dose propofol, as pretreatment agent/s is capable of speeding up and improving the quality of laryngeal mask airway (LMA) insertion in tidal-breathing induction technique with high-concentration sevoflurane. Methods: One hundred and twenty patients were assigned to one of the three groups: Group S, induction with 8% sevoflurane only; Group F+S, 1.0 μg/kg fentanyl prior to induction; and Group F+P+S, 1.0 μg/kg fentanyl and 0.5 mg/kg propofol prior to induction. Results: It was demonstrated that the time from administion of drug (drugs) to loss of eyelash reflex (P < 0.05, Group F+P+S vs. F+S; P< 0.01, Group F+P+S vs. S), to jaw relaxation (P< 0.05, Group F+P+S vs. S) and time taken for LMA insertion (P < 0.01, Group F+P+S vs. S) were all shorter in Group F+P+S, with fewer complications (coughing and involuntary movement) during induction, however, the first time success rate with LMA insertion did not significantly differ among the comparing groups. According to a postoperative inquiry (by questionnaire), there were significantly more patients in the Group F+P+S (57.5%) who considered the induction as pleasant (P < 0.05), of whom 75% expressed that they would be willing to undergo an induction of the same form again in the future (P < 0.05). This more positive rating may be related to the mild sedative effects of the agents given and shorter induction time, which significantly helped reduce the rate of recall of the unpleasant gas. Conclusions: The results of this study of LMA insertion, for ASA I or II adult patients undergoing the tidalbreathing technique with 8% sevoflurane, suggest that pretreatment with 1 μg/kg fentanyl plus 0.5 mg/kg propofol is superior in comparison with either pretreatment with 1 μg/kg fentanyl or absence of pretreatment.