背景:SARS-CoV-2传播的多种模式,包括空中传播,液滴,导致2019年冠状病毒病(COVID-19)的接触和粪便-口腔传播对全球人民的生命造成了公共威胁。在全身麻醉恢复期间,呼吸道感染(尤其是SARS-CoV-2)的患者因咳嗽而产生的大量气溶胶和呼气流量峰值是医护人员感染的最高风险因素。在拔管前进行镇静可显着降低全身麻醉恢复期间咳嗽的发生率。然而,关于在麻醉后监护病房(PACU)BIS引导镇静下拔除气管导管的研究较少。我们推测右美托咪定和丙泊酚的BIS引导镇静能更好地预防气管拔管引起的咳嗽,并降低呼气流量峰值。
方法:将全身麻醉患者随机分为S组(右美托咪定在手术室输注30分钟,并通过在PACU中输注丙泊酚以0.5〜1.5μg/ml维持脑电双频指数(BIS)值60-70,直至拔出气管导管)和C组(不使用右美托咪定和丙泊酚治疗,替换为盐水处理)。咳嗽的发生率,躁动和主动拔管,评估了气管内导管的耐受性以及自主呼吸和拔管时的最大呼气流量。
结果:共101例患者随机分为S组(51例)和C组(50例)。咳嗽的发生率,躁动和主动拔管显著降低(1(51),0(51)和0(51)分别)在S组中比(11(50),8(50)和5(50),分别)在C组中(分别为p<0.05或p<0.01);S组咳嗽评分(1(1,1))比C组(1(1,2))显着降低(p<0.01);S组气管内导管耐受性(0(0,1))比C组(1(1,3))显着提高(p<0.001)。自主呼吸和拔管时的呼气流量峰值显着降低(5(5,7)和6.5(6,8),分别)在S组中比在C组中(8(5,10)和21(9,32))(p<0.001)。
结论:使用右美托咪定和丙泊酚的BIS引导镇静可显著预防全身麻醉恢复过程中的咳嗽并降低呼气峰流速,这可能在防止医务人员感染COVID-19方面发挥重要作用。
背景:中国临床试验注册:ChiCTR2200058429(注册日期:09-04-2022)“回顾性注册”。
BACKGROUND: The multiple modes of SARS-CoV-2 transmission including airborne, droplet, contact and faecal-oral transmissions that cause coronavirus disease 2019 (COVID-19) contribute to a public threat to the lives of people worldwide. Heavy aerosol production by coughing and the big peak expiratory flow in patients with respiratory infections (especially SARS-CoV-2) during recovery from general anaesthesia are the highest risk factors for infection in healthcare workers. To perform sedation before extubation significantly reduced the incidence of coughing during recovery from general anaesthesia. However, there are few studies on endotracheal tube removal under BIS-guided sedation in postanaesthesia care unit (PACU). We speculated that the BIS-guided sedation with dexmedetomidine and propofol would better prevent coughing caused by tracheal extubation and reducing peak expiratory flow.
METHODS: Patients with general anaesthesia were randomly assigned to Group S (dexmedetomidine was infused in the operating room for 30 min, and the bispectral index (BIS) value was maintained 60-70 by infusion propofol at 0.5~1.5 μg/ml in the PACU until the endotracheal tubes were pulled out) and Group C (no dexmedetomidine and propofol treatment, replaced with the saline treatment). The incidence of coughing, agitation and active extubation, endotracheal tube tolerance and the peak expiratory flow at spontaneous breathing and at extubation were assessed.
RESULTS: A total of 101 patients were randomly assigned to Group S (51 cases) and Group C (50 cases). The incidence of coughing, agitation and active extubation was significantly lower (1(51), 0(51) and 0(51), respectively) in Group S than (11(50), 8(50) and 5(50), respectively) in Group C (p < 0.05 or p < 0.01, respectively); the scores of cough were significantly reduced (1(1, 1)) in Group S than (1(1, 2)) in Group C (p < 0.01); and the endotracheal tube tolerance was significantly improved (0(0, 1)) in Group S than (1(1, 3)) in Group C (p < 0.001). The peak expiratory flow at spontaneous breathing and at extubation was significantly reduced (5(5, 7) and 6.5(6, 8), respectively) in Group S than (8(5, 10) and 21(9, 32)) in Group C (p < 0.001).
CONCLUSIONS: BIS-guided sedation with dexmedetomidine and propofol significantly prevented coughing and reduced peak expiratory flow during recovery from general anaesthesia, which may play an important role in preventing medical staff from contracting COVID-19.
BACKGROUND: Chinese Clinical Trial Registry: ChiCTR2200058429 (registration date: 09-04-2022) \"retrospectively registered\".