文档介绍：儿童日间手术中
七氟醚和异丙酚的比较
Economic pressure
Increase in day-case elective surgery
In UK > 50 % elective surgery
Day-case surgery
Avoidance of an overnight admission
Minimal lifestyle dsruption
Day-case Surgery
: Highest quality during and aftersurgery care
: Minimized postoperative morbidity
- Pain
- nausea and vomitting ( PONV)
Halothane Sevoflurane/Propofol
Sevoflurane
Low blood-gas solubility
Non pungent smell
Rapid induction of,emergence from anaethesia
Propofol Rapid emergence
PONV Propofol < Sevoflurane
Methods
Population : Aged 3-12 yr , General/ENT surgery
October 1999- January 2001
To detect a reduction of PONV 20 10 %
Required 440 population
Fit to Hospital Day-case protocol
Precluded Factor
History of Allergic
or other serious adverse experience of anaesthesia
Severe cardiovascular
Respiratory, Metabolic ,
Central nervous system disease
anticipated airway management problem
anaesthetic regimen include inylcholine
322 children were studied
Randomise to one of two study group
Group P/H : iv Propofol(+lidocaine) induction
Halothane/Nitrous oxide maintenance
Group S : Sevoflurane /Nitrous oxide
induction and maintenance
On admission
- topical anaesthetic cream
apply to both hand
- Parents were present during induction
- routine monitoring
: NIBP , EKG , Pulse oximetry
: Gas monitoring (inspire+expire)
- carbon dioxide
- volatile agent concentration
Can’t blind Anaesthetist
Drug dose individual Anaesthetist
FGS was fixed at 70-100 ml/kg/min
via Mapleson A/F
50-70% Nitrous Oxide
Airway maintenance
Non-depolarizing neuromuscular
blocking agent
Individual to Anaesthetist