An Analysis of Anesthesia-Controlled Operating Room Time After Propofol-Based Total Intravenous Anesthesia Compared with Desflurane Anesthesia in Ophthalmic Surgery: A Retrospective Study

作者：Wu Zhi Fu; Jian Guan Shiung; Lee Meei Shyuan; Lin Chin; Chen Yi Fang; Chen Yi Wen; Huang Yuan Shiou; Cherng Chen Hwan; Lu Chueng He^*

来源：Anesthesia and Analgesia, 2014, 119(6): 1393-1406.

DOI：10.1213/ANE.0000000000000435

BACKGROUND: Anesthetic techniques can contribute to reduction of anesthesia-controlled time to improve operating room (OR) efficiency. However, little is known about the difference in anesthesia-controlled time between propofol-based total IV anesthesia (TIVA) and desflurane anesthesia (DES) techniques for ophthalmic surgery under general anesthesia. %26lt;br%26gt;METHODS: We performed a retrospective analysis using hospital databases to compare the anesthesia-controlled times of ophthalmic surgery patients receiving either TIVA via target-controlled infusion with propofol/fentanyl or desflurane/fentanyl-based anesthesia between January 2010 and December 2011. The various time intervals (surgical time, incision to surgical completion and application of dressings;.anesthesia time, start of anesthesia to extubation; extubation time, surgery complete and dressings applied to extubation; time in OR, arrival in the OR to departure from the OR; postanesthetic care unit (PACU) stay time, arrival in the PACU to discharge from the PACU to the general ward; and total surgical suite time, arrival in the OR to discharge from the PACU to the general ward) that comprise a patient%26apos;s hospital stay and the incidence of postoperative nausea and vomiting were compared between the 2 anesthetic techniques. %26lt;br%26gt;RESULTS: We included data from 1405 patients, with 595 patients receiving TIVA and 810 receiving DES. The extubation time was faster (TIVA-DES = -1.85 minutes, 99.2% confidence interval [Cl], -2.47 to -1.23 minutes) and the PACU stay time was shorter (TIVA-DES = -3.62 minutes, 99.2% Cl, -6.97 to -0.10 minutes) in the TIVA group than in the DES group. However, there was no significant difference in total surgical suite time between groups (TIVA-DES = -5.03 minutes, 99.2% Cl, -11.75 to 1.69 minutes). We performed the random-effects analyses while stratifying for procedure and showed that the extubation time in the TIVA group was faster by 14% (99.2% Cl, 9% to 19%, P %26lt; 0.0001) relative to the DES group, and the PACU stay time was faster by 5% (99.2% Cl, 1% to 10%, P = 0.002). Significantly fewer patients suffered postoperative nausea and vomiting and required rescue therapy in the TIVA group than in the DES group (11.3% vs 32.2%, risk difference 21.0%, 95% Cl, 16.9% to 25.1%, P %26lt; 0.001 and 23.9% vs 54.0%, risk difference 30.1%, 95% Cl, 18.3% to 42.0%, P = 0.002, respectively). %26lt;br%26gt;CONCLUSIONS: In our hospital, the use of TIVA reduced the mean time to extubation by at least 9% and PACU stay time by more than 1% when compared with the use of DES anesthesia for ophthalmic surgery.

• 出版日期2014-12