So sánh chất lượng hồi tỉnh của hai kỹ thuật “thoát mê” khi gây mê dòng thấp bằng desflurane cho bệnh nhân phẫu thuật nội soi cắt ruột thừa=Comparison of recovery characteristics with two different washout techniques of desflurane anaesthesia to patients undergoing laparoscopic appendectomy

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Tác giả: Xuân Quang Vũ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Y học cộng đồng, 2023

Mô tả vật lý: tr.151-158

Bộ sưu tập: Metadata

ID: 477572

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Currently, administering anesthesia to patients using Desflurane has become popular due to the numerous advantages of this anesthetic agent, especially its short washout time, attributed to its low blood-gas partition coefficient. This results in patients having a shorter period for extubation and a good quality of recovery. In clinical practice, anesthesiologists often prefer to remove the endotracheal tube (ETT) promptly in the operating room. Therefore, during the washout phase, a high fresh gas flow (FGF) is used for rapid elimination of the anesthetic agent (Purging Technique: PT) instead of maintaining a low FGF for a slower elimination (Slow Elimination: SE). In our study, we hypothesize that maintaining a slow elimination (SE) of Desflurane will yield similar results in terms of extubation time and quality of recovery when compared to the high FGF elimination technique (PT). Objective: Comparison of recovery characteristics of slow elimination (SE) with purging technique (PT) when administering low-flow desflurane anesthesia to patients undergoing laparoscopic appendectomy. Methods: We performed a double blind, randomized study was conducted on 60 patients aged 18 to 60 years with ASA classification <
III, who underwent laparoscopic appendectomy. The patients were randomly divided into two groups: The SE group and the PT group. Both groups received low-flow Desflurane anesthesia following the protocol from induction to maintenance. During the washout phase, the SE group maintained a low FGF of 0.8 L/minute, while the PT group maintained an FGF of 8 L/minute. The time for emergence and extubation, emergence agitation (EA) and time for psychomotor recovery were noted. Results: Time for emergence (Group SE: 17,1 ± 6,7 vs. Group PT: 4,2 ± 1,1 min) and emergence to extubation duration (Group SE: 96 ± 27 s vs. Group PT: 8,7 ± 1,3 s
p = 0,001) were longer in the Group SE than in Group PT. EA occurred in 17% patients in Group SE and in 3,2% patients in Group PT. Psychomotor recovery to baseline value was seen in more number of patients in Group SE than Group PT at 30 min. There was no difference between the groups at 60 min post-extubation. Conclusion: Slow elimination using FGF of 0.8 L/min significantly prolongs emergence even with low soluble agent like desflurane. SE is not beneficial in decreasing the incidence of EA or hastening psychomotor recovery than PT.Hiện nay gây mê cho bệnh nhân bằng Deflurane trở nên phổ biến do thuốc mê có nhiều ưu điểm - đặc biệt là thời gian thoát mê của bệnh nhân ngắn do tỉ lệ gắn thuốc mê/máu thấp (low blood-gas partition), do vậy bệnh nhân có thời gian rút ống nội khí quản ngắn và chất lượng hồi tỉnh tốt. Trên thực hành lâm sàng khi gây mê bằng Desflurane các bác sĩ: Gây mê mong muốn rút ống nội khí quản (NKQ) trên bàn mổ do vậy trong thời kỳ thoát mê sẽ sử dụng dòng khí cao để thải trừ thuốc mê nhanh (Purging Technique: PT) thay vì duy trì dòng khí thấp để thải trừ thuốc mê từ từ (Slow Elimination: SE). Trong nghiên cứu của chúng tôi đưa ra giả thuyết: Duy trì thải trừ thuốc mê Desflurane từ từ (SE) sẽ có thời gian rút ống nội khí quản và chất lượng hổi tỉnh như phương pháp thải trừ nhanh (PT) Mục tiêu: So sánh chất lượng hồi tỉnh khi gây mê dòng thấp bằng Desflurane cho bệnh nhân phẫu thuật nội soi cắt ruột thừa khi thoát mê bằng hai phương pháp: Thoát mê từ từ (slow elimination: SE) và thoát mê nhanh (purging technique: PT) Đối tượng - Phương pháp nghiên cứu: Nghiên cứu lâm sàng tiến cứu, ngẫu nhiên, trên 60 bệnh nhân từ 18 - 60 tuổi với phân loại ASA <
III được phẫu thuật nội soi cắt ruột thừa và chia ngẫu nhiên làm 2 nhóm: Nhóm SE và nhóm PT, cả hai nhóm sẽ được gây mê bằng Desflurane dòng thấp theo quy trình từ lúc khởi mê và duy trì mê. Trong thời gian thoát mê: Nhóm SE vẫn duy trì dòng khí thở FGF là 0,8 L/phút còn nhóm PT sẽ duy trì dòng khí thở FGF là 8 L/phút, đánh giá các chỉ số sinh tồn của bệnh nhân và thời gian rút nội khí quản cũng như chất lượng hồi tỉnh của hai nhóm bệnh nhân. Kết quả: Thời gian thoát mê trung bình của nhóm SE = 17,1 ± 6,7 phút kéo dài hơn nhóm PT = 4,2 ± 1,1 phút, thời gian từ lúc thoát mê đến khi rút ống nội khí quản nhóm SE = 96 ± 27 giây và nhóm PT = 8,7 ± 1,3 giây sự khác biệt có ý nghĩa thống kê với p = 0,001. Bệnh nhân kích thích (EA: Emergence Agitation) ở nhóm SE = 17% và ở nhóm PT = 3,2%
Tinh thần bệnh nhân về trạng thái bình thường quan sát ở nhóm SE tốt hơn ở nhóm PT trong 30 phút đầu sau rút ống NKQ, tuy nhiên sau 60 phút sau rút ống NKQ thì hai nhóm giống nhau. Kết luận: SE với dòng khí 0,8 L/phút làm tăng thời gian tỉnh và thời gian rút ống NKQ cho bệnh nhân, qua đó phương pháp SE không làm tăng lợi ích và chất lượng hồi tỉnh so với phương pháp PT.

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