通过改变眼手术的儿童的麻醉方案对术后吐的影响:中断时间序列分析
Taiki Kojima1,2, Yusuke Yamauchi3, Sayuri Yasuda4
1Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu, Japan.
Paediatric anaesthesia
|August 22, 2025
概括
在小儿眼手术中,转换为用德克萨米 (DEX) 进行的普罗波/阿片类全静脉麻醉 (TIVA) 显著减少了术后吐 (POV). 在此疗程中添加丹塞 (OND) 并没有进一步降低POV发病率.
科学领域:
- 麻醉学
- 儿童手术
- 药理学
背景情况:
- 手术后吐 (POV) 是儿童眼手术的一个问题.
- 基于普罗波的静脉全麻醉 (TIVA),德克萨米松 (DEX) 和丹塞 (OND) 均表现出单独的抗作用.
- 在现实环境中,DEX和OND与普罗波/阿片类药物TIVA对POV的联合作用尚未得到充分证实.
研究的目的:
- 评估儿童眼手术中的纵向POV发病率.
- 在三种不同的麻醉方案中比较POV率.
- 评估麻醉剂修改对POV预防的影响.
主要方法:
- 在日本一家三级儿童医院进行了回顾性观察研究.
- 包括未满18岁的儿童接受眼手术而没有严重的并发症.
- 在24小时内分析POV或抗药的使用,分为三个阶段:sevoflurane/pentazocine,propofol/opioid TIVA与DEX,以及propofol/opioid TIVA与DEX和OND.
主要成果:
- 整体POV发病率从23. 1% (第一阶段) 显著下降到6. 9% (第二阶段) (p < 0. 001).
- 在第3阶段进一步添加OND导致POV发病率为4. 3%,与第2阶段没有显著变化.
- 间断时间序列分析显示,从第一阶段到第二阶段的POV水平有显著变化,但从第二阶段到第三阶段没有变化.
结论:
- 在小儿眼手术中,切换为与DEX一起使用的TIVA/阿片类药物有效减少了POV.
- 将OND添加到与DEX一起的propofol/ opioid TIVA中没有进一步显著降低POV.
- 需要进行进一步的研究,以优化TIVA中结合药物的抗策略,以便在现实世界中应用.
相关概念视频
Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists
321
5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
321
General Anesthesia: Overview
283
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
283
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
171
Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
171
Parenteral Anesthetics: Overview
196
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
196
Stages of General Anesthesia
689
Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
689
Chemotherapy-Induced Nausea and Vomiting: Dopamine Receptor Antagonists
440
Dopamine receptor antagonists, also known as antipsychotic agents, are critical in managing chemotherapy-induced vomiting. These antiemetic agents block dopamine receptors in the chemoreceptor trigger zone (CTZ), inhibiting signal transmission to the vomiting center. Antipsychotic agents encompass phenothiazines (PTZ), butyrophenones, benzamides, and thienobenzodiazepines (Zyprexa), which are utilized for their antiemetic and sedative properties.
Phenothiazines, such as prochlorperazine...
Phenothiazines, such as prochlorperazine...
440


