The effect of PCA with tramadol and fentanyl on postoperative sleep pattern in patients with obstructive sleep apnea syndrome / 中华麻醉学杂志

ABSTRACT

Objective The purpose of this study was to determine and compare the effect of patient controlled analgesia(PCA) with tramadol and fentanyl on postoperative sleep pattern in patients with severe obstructive sleep apnea syndrome(OSAS) Methods Forty five ASA Ⅱ patients with severe OSAS undergoing uvula palate pharyngoplasty(UPPP) were randomly divided into 3 groups of 15 patients each according to the postoperative PCA the patients received 1) tramadol group; 2) fentanyl group and 3) control group The patients were premedicated with intramuscular atropine 0 01mg?kg -1 .The patients were adequately sedated (Ramsay Ⅱ Ⅲ) with midazolam 0 03 mg?kg -1 and fentanyl 2?g?kg -1 Awake intubation was performed under topical anesthesia Anesthesia was then induced with propofol 1 5 2 0 mg?kg -1 and maintained with inhalation of 1 0% 1 5% isoflurane and 60% N 2O and intermittent intravenous boluses of vecuronium PCA was started when the patients were awake Tramadol 500mg (tramadol group) and fentanyl 500?g (fentanyl group) were diluted to 100ml(tramadol 5mg?ml -1 , fentanyl 5?g?ml -1 ) A loading does of 10ml was given followed by continuous intravenous infusion at a rate of 3ml?h -1 PCA bolus does was 1 5ml and lock out time 10 min Polysomnography(PSG) was continuously monitored and recorded the first night after operation from 10 pm to 6 am next morning According to Rechtschaffen standard sleep was divided into 6 stages stage Ⅰ, stage Ⅱ, slow wave sleep(SWS)(stageⅢ+Ⅳ), stageV (rapid eye movement REM) and stage Ⅳ(awake) Results During the 480 min of PSP monitoring, SWS was (13 06?7 56) min in tramadol group, (9 2?7 26) min in fentanyl group and (6 33?4 68)min in control group and the total sleep time (TST) was (197 4?84 48) min in tramadol group, (148 33?72 73)min in fentanyl group and (124 13?61 38)min in control group SWS and TST were significantly longer in tramadol group than those in control group(P