Comparison of Fistulectomies Conducted under Intravenous General Anesthesia or Heavy Sedation with Midazolam and Meperidine

目的：肛門廔管手術的術中與術後的疼痛是患者考量接受手術的一個重點，也是醫療品質與花費的議題。因此，我們比較目前常用的靜脈全身麻醉與朦朧麻醉的麻醉方式，希望了解其效果。方法：我們藉由一個回溯性的研究來探討不同麻醉方式對於手術、疼痛、與併發症之影響。有一組病患族群接受使用靜脈麻醉之廔管切除術，而另外一組病人接受使用朦朧麻醉之廔管切除手術。分析預後的因子包括手術時間、疼痛指數、住院天數、及併發症。結果：200位有單純或複雜性肛門廔管之病患接受廔管切除手術，其中91例接受靜脈全身麻醉，另外109個病患接受朦朧麻醉。靜脈麻醉組與朦朧麻醉組病患關於年齡、身高體重、複雜性廔管比例並無統計學的差異。兩組病人手術時間以靜脈麻醉較長（51.44 minutes vs. 39.94 minutes），術後止痛藥使用以靜脈麻醉組較多（82.58 mg vs. 31.65 mg）。關於住院天數、手術併發症則無統計學顯著性差異。結論：從我們的統計來看於兩種麻醉方式對於廔管手術都是安全有效的方式。然而，朦朧麻醉可提供較快的手術時間，減少術後麻醉恢復時間，術後疼痛也較不嚴重。

關鍵字

肛門廔管手術；朦朧麻醉；靜脈麻醉

並列摘要

Introduction. Anesthesia and postoperative pain are the main concerns of patients scheduled to undergo fistulectomies. Although several types of anesthesia are used for this procedure, opinions as to the simplest and most effective type are controversial. We compared the effects of heavy sedation and intravenous general anesthesia to clarify this issue.Methods. We retrospectively studied medical records of patients who were diagnosed with an anal fistula and underwent surgical treatment at our institute. Patients were given intravenous general anesthesia or heavy sedation during surgery. Outcomes were patient characteristics, medication dose, postoperative pain score, and complications.Results. Two hundred patients were enrolled in the study: 91 received intravenous general anesthesia (group 1) and 109 patients received heavy sedation (group 2). A further 10 patients were excluded because of incomplete admission data. There were no significant differences between groups 1 and 2 in age, ASA classification, body weight, or duration of hospital stay. However, the duration of surgery was longer in group 1 than in group 2 (51.03 ±18.745 minutes vs. 38.37 ±13.581 minutes, p ＜ 0.01). The postoperative meperidine dose was greater for group 1 than for group 2 (82.58 ±79.808 mg vs. 31.65 ±50.305 mg, p ＜ 0.01). Postoperative pain score was higher for group 1. None of the patients developed major surgical or anesthetic complications, including respiratory complications.Conclusion. Both anesthetic methods were safe and effective and did not differ in the incidence of postoperative complications. However, patients who received heavy sedation experienced less postoperative pain and required less medication, which simplifies hospital treatment and reduces occupancy of the post-anesthesia care unit with an associated reduction in costs.

並列關鍵字

Fistulectomy ； Heavy sedation ； Intravenous general anesthesia

國際替代計量

Comparison of Fistulectomies Conducted under Intravenous General Anesthesia or Heavy Sedation with Midazolam and Meperidine

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