- 期刊
Total Intravenous Anesthesia Using Propofol and Ketamine for Ambulatory Gynecologic Laparoscopy
Propofol和Ketamine全靜脈麻醉應用於婦科門診腹腔鏡手術
摘要
藉全靜脈麻醉使病患於自發性呼吸下接受腹腔鏡手術已常見於婦科常規手術。本研究評估以propofol和ketamine維持腹腔鏡手術之麻醉效果，並與插管全身麻醉比較。58位年齡17至48歲的女性被分成兩組。第一組病人接受propofol誘導及propofol的持續灌注。術前給予靜脈ketamine加強propofol麻醉效果。麻醉中病患以自然呼吸道維持自發性呼吸。第二組病人被施以插管全身麻醉及以isoflurane維持麻醉，再以呼吸器控制呼吸。結果顯示兩組病人之pH和PaCO2在術中及恢復室園現的相似趨勢。第二組於手術中之心不整發生率高於第一組（40％比3％；p＜0.001）。第二組於手術後之嘔吐發生率高於第一組（30％比7％；p＜0.05）。第二組於手術後之喉嚨痛發生率高於第一組（47％比7％；p＜0.001）。我們認為propofol和ketamine之全靜脈麻醉方式可適用於門診之婦科腹腔鏡手術。
關鍵字
無資料並列摘要
Laparoscopy under total intravenous anesthesia (TIVA) with spontaneous respiration is a commonly encountered procedure in ambulatory gynecologic surgery. The purpose of this study was to evaluate the efficacy of TIVA using propofol and ketamine, compared with endotracheal inhalational general anesthesia (EIGA) for ambulatory gynecologic laparoscopy. Fifty-eight female patients, aged 17 ~ 48 years, were randomly allocated into two groups. Group 1 (TIVA) (n= 28) received propofol at the induction of anesthesia followed by propofol infusion for maintenance. Intravenous ketamine 0.5 mg/kg was administered before operation for anesthetic effect. Natural airway and spontaneous breathing were then maintained in patients. Group 2 (n= 30) received EIGA with isoflurane under controlled ventilation. We found that the two groups demonstrated similar trend characters of pH and PaCO2 during operation and in recovery room. The incidence of postoperative vomiting was higher in group 2 than in group 1 (30% vs. 7%; p ＜0.050). The incidence of intraoperative arrhythmia was higher in group 2 than in group 1 (40% vs. 3%; p＜0.001). Furthermore, the incidence of sorethroat was higher in group 2 than in group 1 (47% vs. 7%; p＜0.001). We conclude that TIVA with spontaneous respiration is suitable for ambulatory gynecologic laparoscopy.
延伸閱讀
- Chen, L. K., Chang, Y., Liu, C. C., & Hou, W. Y. (1998). 利用硬脊膜外腔麻醉合併使用Propofol靜脈安眠麻醉對接受經腹腔子宮切除術的Amyotrophic Lateral Sclerosis患者的病歷報告. Acta Anaesthesiologica Sinica, 36(2), 103-106. https://www.airitilibrary.com/Article/Detail?DocID=P20170519003-199806-201904170007-201904170007-103-106
- 張道仲、朱僑光（1998）。迷你腹腔鏡手術合併使用局部麻醉於婦科之應用。中華民國內膜異位症婦女協會會刊，5(5)，4-4。https://doi.org/10.6498/EA.1998.5(5).3
- 詹景全、金承惠、莊玲璇、張玲瑜、李靜瑜（2012）。V-Loc^TM 180優施西可吸收傷口縫合裝置運用於腹腔鏡子宮肌瘤切除手術的經驗。北市醫學雜誌，9(4)，319-328。https://doi.org/10.6200/TCMJ.2012.9.4.02
- Chuang, W. M., Tse, J., Chen, P. C., Lin, W. C., LI, I. C., & SU, M. P. (2016). 臂神經叢阻斷術配合propofol鎮靜於接受動靜脈廔管手術之透析病人有較優之圍術期結果. 疼痛醫學雜誌, 26(2), 69-76. https://www.airitilibrary.com/Article/Detail?DocID=10217959-201609-201701230009-201701230009-69-76
- Chin, C. H., & Chan, C. C. (2005). Sevoflurane面罩式吸入麻醉在婦産科門診手術之應用. 北市醫學雜誌, 2(1), 48-53. https://doi.org/10.6200/TCMJ.2005.2.1.08