Does pressure support ventilation improve the postoperative outcome of adeno-tonsillectomy patients? A prospective randomized trial

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• 作者：Hisham H. Abdelwahab^a ; ^{hishamhosny@kasralainy.edu.eg} ; Ahmed Mohammed Omar^a ; ^b ; ^{ahmedmommer@yahoo.com} ; Ossama Hamed Abushanab^a ; ^{ossamaaboushanab@yahoo.com}
• 关键词：Pediatric anesthesia ; Adenotonsillectomy ; Pressure support ventilation ; Spontaneous ventilation
• 刊名：Egyptian Journal of Anaesthesia
• 出版年：2012
• 期刊代码：pca120_11101849
• 类别：med
• 出版时间：April, 2012
• 卷：28
• 期：2
• 页码：157-161
• 文件大小：564 K

摘要

Background

Spontaneous ventilation (SV) is used for adeno/tonsillectomy in children. However, inhalational anesthetics produce dose dependent decrease in minute ventilation. We tested the impact of PSV on awakening time, and length of PACU stay.

Methods

34 patients were randomized into two groups; PS ventilation group and SV group. Premedication and induction were similar in both groups. Patients in PS group were ventilated with P_insp set to deliver 8 ml/kg V_T, keeping ETCO₂ between 35 and 45 mmHg. Any episodes of hypoventilation were recorded and corrected by manual support of ventilation.

Upon completion of surgery, time-to-extubate was recorded. Length of PACU stay, agitation and CHEOPS scores, PONV and desaturation episodes were also recorded. Results are presented as mean (SD), median (interquartile range), or number of patients as appropriate. A P value < 0.05 was considered significant.

Results

Extubation time (min) [mean (SD)] was longer in SV group than PS group [7.8 (2.1) vs. 5.5(1.4), P < 0.001]. In the SV group 9 patients had episodes of hypoventilation that necessitated manual assist of ventilation. Pain scores were higher in SV group than PS group. Duration of stay in PACU [mean (SD)] in minutes was longer in SV group than PS group [44.3(7.4) vs. 39.4(5.7), P = 0.02]. All but one patient in the PS group needed postoperative rescue meperidine analgesia. The mean (SD) time needed for rescue meperidine analgesia was 27.1(8.9) in PS group and 21.8(9.4) in SV group (P = 0.04).

Conclusion

PSV carries the advantages of overcoming the effects of narcotics and inhaled anesthetics on spontaneously ventilated adeno-tonsillectomy patients. They suffer less pain and spend less time in the PACU.