背景:右美托咪定,α2-肾上腺素能激动剂,当用作成人全静脉麻醉的辅助手段时,可以减少异丙酚和瑞芬太尼的需求,但是在儿科人群中的研究很少。这项研究调查了诱导后右美托咪定推注对小儿手术中丙泊酚和瑞芬太尼需求的剂量节省作用。
方法:在本随机分组中,双盲,对照试验,接受择期牙科手术的2-10岁儿童被分为四组:安慰剂,0.25mcg/kg右美托咪定,0.5mcg/kg右美托咪定,和1mcg/kg右美托咪定。固定比例丙泊酚和瑞芬太尼全静脉麻醉的维持遵循脑电双频指数(BIS)引导算法,旨在保持稳定的麻醉深度。主要结果是异丙酚和瑞芬太尼的时间平均维持输注率。麻醉后护理单元的次要结果包括镇静评分,疼痛评分,和出院时间。
结果:67例患者的数据可用于分析。1mcg/kg右美托咪定组(180[164-185]mcg/kg/min)与安慰剂组(200[178-220]mcg/kg/min)相比,丙泊酚输注速率的中位数[四分位数范围]更低:百分比变化-10.0%;95%CI-2.4至-19.8;p=0.013。1mcg/kg右美托咪定组(0.089[0.080,0.095]mcg/kg/min)与安慰剂组(0.103[0.095,0.106]mcg/kg/min)的瑞芬太尼输注速率也较低:百分比变化,-13.7%;95%CI-5.47至-21.0;p=0.022。然而,丙泊酚和瑞芬太尼输注速率在0.25或0.5mcg/kg右美托咪定组中均无显著差异.在麻醉后监护室,疼痛或镇静评分没有差异,任何右美托咪定组的出院时间均无明显延长.
结论:右美托咪定1mcg/kg降低了诱导后推注给药时儿童麻醉维持期间异丙酚和瑞芬太尼的需求量。
背景:ClinicalTrials.gov:NCT03422978,注册日期2018-02-06。
BACKGROUND: Dexmedetomidine, an α2-adrenergic agonist, reduces propofol and remifentanil requirements when used as an adjunct to total intravenous anesthesia in adults, but studies in a pediatric population are sparse. This study investigates the magnitude of dose-sparing effects of a postinduction dexmedetomidine bolus on propofol and remifentanil requirements during pediatric surgery.
METHODS: In this randomized, double-blind, controlled trial, children aged 2-10 years undergoing elective dental surgery were assigned to one of four groups: placebo, 0.25 mcg/kg dexmedetomidine, 0.5 mcg/kg dexmedetomidine, and 1 mcg/kg dexmedetomidine. Maintenance with fixed-ratio propofol and remifentanil total intravenous anesthesia followed a bispectral index (BIS)-guided algorithm designed to maintain a stable depth of anesthesia. The primary outcomes were time-averaged maintenance infusion rates of propofol and remifentanil. Secondary outcomes in the postanesthetic care unit included sedation scores, pain scores, and time to discharge.
RESULTS: Data from 67 patients were available for analysis. The median [interquartile range] propofol infusion rate was lower in the 1 mcg/kg dexmedetomidine group (180 [164-185] mcg/kg/min) versus placebo (200 [178-220] mcg/kg/min): percent change -10.0%; 95% CI -2.4 to -19.8; p = 0.013. The remifentanil infusion rate was also lower in the 1 mcg/kg dexmedetomidine group (0.089 [0.080, 0.095] mcg/kg/min) versus placebo (0.103 [0.095, 0.106] mcg/kg/min): percent change, -13.7%; 95% CI -5.47 to -21.0; p = .022. However, neither propofol nor remifentanil infusion rates were significantly different in the 0.25 or 0.5 mcg/kg dexmedetomidine groups. In the postanesthesia care unit, there were no differences in pain or sedation scores, and time to discharge was not significantly prolonged in any dexmedetomidine group.
CONCLUSIONS: Dexmedetomidine 1 mcg/kg reduced the propofol and remifentanil requirements during maintenance of anesthesia in children when administered as a postinduction bolus.
BACKGROUND: ClinicalTrials.gov: NCT03422978, date of registration 2018-02-06.