一篇设计和实施均简单的文章（摘自神经外科麻醉2009.1）

chexuehua1972

Bispectral Index-guided Administration of Anesthesia for Transsphenoidal Resection of Pituitary Tumors: A Comparison of 3 Anesthetic Techniques.
Clinical Investigations
Journal of Neurosurgical Anesthesiology. 21(1):10-15, January 2009.
Ali, Zulfiqar MD; Prabhakar, Hemanshu MD; Bithal, Parmod K. MD; Dash, Hari H. MD
Abstract:
The main aims of anesthesia for pituitary surgery include maintenance of hemodynamic stability, provision of conditions that facilitate surgical exposure, and a smooth emergence to facilitate a prompt neurologic assessment. The primary aim of our study was to compare the effects of 3 anesthetic regimens on hemodynamics and recovery characteristics of the patients. Ninety patients undergoing transsphenoidal surgery were enrolled in the study. Standard anesthesia technique was followed for induction. Patients were randomly divided to receive propofol, isoflurane, or sevoflurane for maintenance of anesthesia. The bispectral index target range during maintenance was 40 to 60. The hemodynamic variables (heart rate and mean arterial pressure) and bispectral index were noted during the various stages of the surgery. The time to emergence and extubation was noted. We evaluated cognitive function at 5 and 10 minutes posttracheal extubation. The 3 study groups were comparable with respect to age, sex, weight, and duration of surgery. We observed an increase in heart rate and blood pressure during intubation, nasal packing, and insertion of self-retaining nasal speculum. After tracheal intubation, the rise in blood pressure was more in sevoflurane group than propofol. During emergence, hypertensive response was seen in all patients. Emergence and extubation times were significantly shorter with propofol and sevoflurane. Patients who received propofol had better cognition scores. Aldrete scores were better with propofol and sevoflurane than isoflurane. The pressor response after intubation and emergence hypertension was significantly less with propofol. Better recovery profile was seen in sevoflurane and propofol groups and a better cognition in patients receiving propofol. Propofol plus nitrous oxide anesthesia could be the technique of choice in patients undergoing transnasal transsphenoidal pituitary surgery. 摘要：
  垂体肿瘤手术麻醉的目标是：1。维持术中稳定的血流动力学指标。 2。为外科暴露提供良好的条件。3。术后迅速和平稳的苏醒以便于神经外科医师对患者行神经学评估。我们这一研究的目的是比较3种不同的麻醉技术对血流动力学和术后苏醒特点的影响。90例拟行经蝶垂体瘤切除的患者被纳入本研究。麻醉诱导采用标准的麻醉技术。病人被随机分入3组（不同的麻醉维持方案），分别为丙泊酚，异氟醚和七氟醚。术中行BIS(脑电双频指数）监测，其目标为维持BIS于40-60。在手术的不同阶段记录血流动力学变量（心率和平均动脉压）以及BIS值。同时记录术后苏醒和拔管时间。在拔管后5，10min评估患者的认知功能。3组在年龄，性别，体重和手术时间等方面无差异。我们观察到在插管，鼻腔填塞和置入鼻窥器时出现血压的上升和心率增快。在插管后，血压上升的程度在七氟醚组要高于丙泊酚组。在苏醒期，3组病人均出现了升压反应。苏醒和拔管时间在丙泊酚组和七氟醚组要明显短于异氟醚组。丙泊酚组的患者术后认知评分更良好。Aldrete评分在丙泊酚组和七氟醚组要显著优于异氟醚组。无论在插管还是苏醒期，使用丙泊酚维持的患者伴有更小的血压波动。丙泊酚加笑气的麻醉方案是经蝶垂体瘤切除术的良好选择。(C) 2009 Lippincott Williams & Wilkins, Inc.

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