Comparison of the efficacy of dexmedetomidine,ketamine, and a mixture of both for pediatric MRI sedation

AimTo compare the efficacy of intramuscular ketamine, dexmedetomidine, and a mixture of both for pediatric MRI sedation.Subjects and methodsOne-hundred and sixty-two children with ASA physical I–II were enrolled in a double-blind comparative study and assigned into three equal groups for sedation. Group D, patients received IM dexmedetomidine 3 μg/kg. Group K, patients received IM ketamine 4 mg/kg. Group DK, patients received a combination of IM dexmedetomidine 1.5 μg/kg and ketamine 2 mg/kg. Primary outcomes included incidence of failed sedation and the requirement of midazolam supplementation. Secondary outcomes were time to sedation, duration of sedation, and discharge time.ResultsThe onset of satisfactory sedation was significantly shorter in the DK group in comparison with the D group (4.8 ± 1.6 vs. 16.8 ± 4.5 min), while no significant difference between the DK group and K group. The duration of sedation was significantly less in the DK group in comparison with the K group, and the discharge time was significantly less in the DK group in comparison with the D and K groups. The sedation failure rate was significantly lower in the DK group (5.6%) in comparison with the K group (22.2%) and the D group (27.8%). The use of rescue midazolam was significantly less in the DK group (0.03 ± 0.12 mg) in comparison with the K and D groups (0.21 ± 0.41 mg, 0.24 ± 0.41 mg, respectively). None of the patients experienced episodes of hypotension or bradycardia in the DK and K groups while four patients (7.4%) experienced episodes of hypotension and five patients (9.3%) experienced episodes of bradycardia in the D group.ConclusionIn pediatric MRI sedation, the combination of IM dexmedetomidine and ketamine was superior to either IM dexmedetomidine or ketamine given individually with regard to the onset of sedation, the sedation failure rate, and hemodynamic stability.     

9985例右美托咪定滴鼻镇静行无创检查患儿的回顾性分析

目的回顾性分析患儿使用右美托咪定滴鼻镇静术行无创性检查的安全性和有效性。方法通过提取本院手术麻醉电子病历系统中的数据,回顾性分析2017年6月至2018年4月在本院镇静镇痛中心行无创性检查的患儿9 985例,年龄≥3个月,体重5～10 kg,右美托咪定滴鼻剂量为1.5～2.5μg/kg,体重10 kg的患儿滴鼻剂量为2.5～3μg/kg,如果镇静失败,可追加一次1μg/kg。统计镇静成功率和不良事件的发生率。结果起始剂量镇静成功8 237例(82.49%),总成功率为94.27%。总计有271例(2.71%,95%CI 2.40%～3.03%)患儿发生不良事件,其中心动过缓有231例(2.31%,95%CI 2.02%～2.61%),为主要不良事件,未发生一例心跳呼吸骤停及死亡。结论右美托咪定滴鼻镇静可安全有效地用于患儿无创性检查。     

Comparison of buccal and intramuscular dexmedetomidine premedication for arthroscopic knee surgery

STUDY OBJECTIVE: To compare the sedative, anxiolytic, analgesic, hemodynamic, and respiratory effects of buccal dexmedetomidine with intramuscular (IM) dexmedetomidine for premedication in patients undergoing arthroscopic knee surgery during spinal anesthesia. DESIGN: Randomized, placebo-controlled trial. SETTING: University medical center. PATIENTS: 75 ASA physical status I and II patients undergoing arthroscopic knee surgery with spinal anesthesia. INTERVENTIONS: Patients were randomized to one of three groups for premedication: group B, buccal dexmedetomidine 2.5 microg kg(-1); group IM, IM dexmedetomidine 2.5 microg kg(-1); and group P, buccal 0.9% and NaCl 2 mL. MEASUREMENTS: Noninvasive blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation were recorded. Sedation and anxiety levels were consecutively assessed with Ramsay sedation scores and Visual Analog Scale (VAS) scores of anxiety before premedication, before spinal anesthesia, during surgery, and at the end of surgery. Two, 4, and 8 hours after surgery, sedation levels, postoperative VAS pain scores, and consumption of analgesics (diclofenac sodium) were recorded. MAIN RESULTS: Before spinal anesthesia, during surgery, and at the end of surgery, sedation and anxiety scores of the patients receiving buccal or IM dexmedetomidine were, respectively, higher and lower than in group P. Patients receiving buccal dexmedetomidine (group B) had lower requirement of diclofenac sodium than group P and lower pain scores than groups P and IM. Mild hypotension and bradycardia were observed in the buccal and IM dexmedetomidine patients. CONCLUSIONS: Buccal dexmedetomidine for premedication in arthroscopic knee surgery provided equal levels of sedation and anxiolysis, and more evident analgesia compared with IM dexmedetomidine.     

Dexmedetomidine sedation in a child with frontonasal encephalocoele scheduled for MRI

Paediatric patients undergoing radiological imaging often require sedation to minimise motion artefacts. Sedation during Magnetic Resonance Imaging (MRI) poses many challenges to the anaesthetist. Inadequate or failed sedation results in difficulty in keeping them motionless while maintaining respiratory and hemodynamic stability. Secondly, limited access to the patient may pose a safety risk during MRI. Dexmedetomidine, an α₂-adrenoceptor agonist, has recently been used as a sedative for diagnostic imaging studies. We report a use of dexmedetomidine for sedation in MRI suite in a child with frontonasal encephalocoele. A two-year-old girl child weighing 11 kg was scheduled for MRI of the brain and paranasal sinuses with nasal cavity under anaesthesia at our institute. After applying standard monitoring, an initial loading dose of dexmedetomidine was given @ 2 μg kg⁻¹ over 10 min followed by continuous infusion of dexmedetomidine @ 1 μg kg⁻¹ h⁻¹. Sedation was monitored by the Ramsay Sedation Score (RSS), and as soon as a score of 5 was achieved, the child was transferred to the MRI table. Anaesthetic conditions were excellent, with minimal change in vital signs during the entire 35 min duration of the scan. Imaging was successful with no motion artefacts.     

不同剂量右美托咪定镇静程度及顺行性遗忘作用研究

目的 观察不同剂量右美托咪定(dexmedetomidine,Dex)对下腹部手术患者术中镇静程度及顺行性遗忘作用的影响. 方法 选择美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级,年龄20岁～60岁,在腰麻硬脊膜外联合阻滞麻醉下复合Dex行下腹部手术(剖宫产术除外)的患者200例,其中男101例,女99例.采用随机数字表法进行分组,根据给予生理盐水或Dex维持剂量的不同分为4组(每组50例):生理盐水组(De0组)、0.2 μg·kg1·h-1组(De1组)、0.4 μg· kf-1·h-1组(De2组)、0.6 μg· kg-1·h-1组(De3组).采用改良警觉/镇静观察评分(observer's assessment of alertness/sedation,OAA/S)法,观察Dex泵入后5 min(T1)、10 min(T2)、15 min (T3)、20 min(T4)、25 min(T5)、30 min(T6)、40 min(T7)和50 min(T8)各时间点患者镇静程度及术后24 h顺行性遗忘情况. 结果 De0组各时间点的OAMS法评分均为(5.00±0)分,De1组、De2组、De3组随着时间的延长,泵入Dex剂量的逐渐增大,OAMS评分逐渐减小(P＜0.05):De1组T2～T8评分依次为(3.15±0.37)、(3.26±0.44)、(2.70±0.66)、(2.55±0.60)、(2.40±0.60)、(2.05±0.76)、(2.02±0.73)分;De2组T2～T8评分依次为(3.10±0.64)、(2.95±0.51)、(2.35±0.67)、(2.25±0.55)、(2.10±0.45)、(1.60±0.50)、(1.65±0.49)分;De3组T2～Ts评分依次为(3.10±0.31)、(2.65±0.49)、(1.95±0.39)、(1.90±0.45)、(1.75±0.44)、(1.20±0.62)、(1.25±0.64)分.De0组无遗忘病例为50例;De1组、De2组、De3组无遗忘病例明显减少(P＜0.05):De1组完全遗忘4例,部分遗忘35例,无遗忘11例;De2组完全遗忘15例,部分遗忘29例,无遗忘6例;De3组完全遗忘29例,部分遗忘19例,无遗忘2例. 结论 Dex具有良好的镇静以及一定的顺行性遗忘作用,且呈剂量依赖性.     

右旋美托咪啶的镇静效应及其对全麻镇静深度的影响

目的研究右旋美托咪啶(Dex)的镇静效应及其对全麻患者麻醉深度的影响。方法择期手术的患者60例(ASAⅠ～Ⅱ级),根据不同用药时期情况均分为镇静组和麻醉组,镇静组30例又分为Dex组(D1组)和对照组(C1组):D1组静脉泵注Dex负荷剂量0.4μg/kg(5min注完),然后以0.4μg·kg-1·h-1维持静注30min;C1组以同样方式输注生理盐水。记录不同时点的脑电双频指数(BIS)、MAP、HR,并对患者进行OAA/S、Ramesay镇静评分。麻醉组30例全麻患者也随机分为D2和C2组:D2组术中静脉Dex0.4μg/kg5min注完;C2组输注生理盐水。术中以丙泊酚靶控输注(TCI)和雷米芬太尼静脉维持麻醉,调节丙泊酚血浆靶控浓度(Ct),使BIS维持在50±3。结果D1组Dex负荷剂量输注后以及维持期间BIS比基础值降低17.0%～30.9%(P<0.05),镇静效应明显,OAA/S和Ramsay镇静评分明显降低(P<0.05);D2组患者麻醉前BIS为92±1,给予Dex后BIS由51±2降至42±16,C2组则仍为51±3。D2组丙泊酚的用量比C2组减少8%～14%(P<0.05)。结论Dex对清醒患者产生明显镇静效应,并能加深全麻患者的麻醉深度,减少丙泊酚TCI的用量。     

右美托咪定关胸前滴鼻对胸腔镜肺癌根治术患者苏醒期镇静镇痛的影响

目的评价右美托咪定滴鼻对胸腔镜下肺癌根治术患者苏醒期镇静镇痛的影响。方法择期全麻下行胸腔镜下肺癌根治术患者120例,男67例,女53例,年龄38～65岁,BMI 18.9～24.6 kg/m~2,ASAⅠ或Ⅱ级,TNM分期Ⅱ或Ⅲ期,采用随机数字表法将患者分为三组(n=40):右美托咪定静脉组(DV组)、右美托咪定滴鼻组(DN组)和对照组(C组)。DV组于关胸前静脉泵注右美托咪定1μg/kg(生理盐水稀释为10 ml,10 min注完);DN组于关胸前双侧鼻孔等量滴入右美托咪定1μg/kg(生理盐水稀释为1 ml),滴速为20滴/分;C组给予等量生理盐水滴鼻。术后患者均采用舒芬太尼PCIA。于拔管后5 min、用药后1、2 h记录Ricker镇静躁动评分(SAS评分)和VAS疼痛评分,记录术后首次追加舒芬太尼时间,术后24 h舒芬太尼总用量和不良反应发生情况。结果与C组比较,DN组和DV组SAS评分在拔管后5 min和用药后1 h明显降低,拔管后5 min VAS评分明显降低,术后首次追加舒芬太尼时间明显延长,术后24 h内舒芬太尼总用量明显减少,出现呛咳反应、高血压和心动过速情况明显减少(P0.05);与DV组比较,DN组心动过缓发生率明显降低(P0.05)。结论右美托咪定静注和滴鼻可改善胸腔镜下肺癌根治术患者苏醒期镇静水平,减少术后阿片类药物使用,同时,滴鼻方式简便易行,临床安全性较高。     

右美托咪啶在乳腺局部活检手术中镇静效果评价

目的评价右美托咪啶（dexmedetomidine,DEX）作为基础镇静用药在麻醉管理监护（monitored anesthesia care,MAC）下行乳腺局部活检手术的安全性及有效性。方法 90例患者采用Excel表产生的组间样本量平衡的随机分组方法分为右美托咪啶负荷组（D1组）、右美托咪啶负荷加维持组（D2组）及安慰剂组（P组）共3组,各30例。D1组和D2组手术开始前30 min静脉泵注50 ml DEX 0.5μg/kg负荷剂量,P组给予50 ml生理盐水,15 min泵注完。D2组静脉泵注完负荷剂量后,持续泵注0.125 ml·kg-1·h-1含4μg/ml（0.5μg·kg-1·h（-1））DEX的生理盐水至手术结束;D1组和P组静脉泵注完负荷剂量后,持续泵注生理盐水0.125 ml·kg-1·h-1至手术结束。手术开始前根据OAA/S镇静评分、VAS镇痛评分予静脉注射咪达唑仑、芬太尼,比较3组患者咪达唑仑、芬太尼的用量及手术满意度。结果 D1组、D2组、P组加用咪达唑仑例数分别为24例（80.0%）、22例（73.3%）、30例（100%）,咪达唑仑用量分别为（1.52±0.94）mg、（0.93±0.65）mg、（3.88〈0.89）mg。D1、D2组加用咪达唑仑例数明显少于P组（P〈0.05）,咪达唑仑用量也明显少于P组（P〈0.05）,D2组较D1组咪达唑仑用量更少（P〈0.05）。3组所有患者均需加用芬太尼,用量分别为（0.15±0.06）mg、（0.12±0.05）mg、（0.23±0.09）mg,D1、D2组芬太尼用量明显少于P组（P〈0.05）,D1和D2组间比较差异无统计学意义。D1及D2组的高血压、心动过速、呼吸抑制的发生率明显低于P组（P〈0.05）,但D1和D2组间比较差异无统计学意义。D1及D2组对手术过程的满意度比P组高（P〈0.05）,但D1和D2组组间比较差异无统计学意义。结论乳腺局部活检手术中,右美托咪啶负荷用药和负荷加维持用药,均能减少咪达唑仑和芬太尼的用量及其循环、呼吸抑制等不良反应的发生,增加患者手术满意度,右美托咪啶负荷加维持用药追加咪达唑仑的用量最少。     

High-dose dexmedetomidine sedation for pediatric MRI

Objectives: To test the hypothesis that high‐dose dexmedetomidine can be successfully used for pediatric magnetic resonance imaging (MRI) sedation without significant hemodynamic compromise. Background: The dexmedetomidine dose required to achieve optimal sedation is often higher than its recommended dose. High doses of dexmedetomidine can lead to significant hemodynamic side effects. Methods: Dexmedetomidine use for pediatric MRI over a 1‐year period was retrospectively reviewed. A dexmedetomidine bolus of 2 μg·kg^?1 intravenous followed by 1 μg·kg^?1·h^?1 infusion was used. Dexmedetomidine efficacy, side effects, timing of side effects, and additional use of medications were analyzed. Data were compared by t‐test, Mann–Whitney rank‐sum test, Fisher’s exact test, and anova . Results: High‐dose dexmedetomidine was used in 77 patients, and MRI was completed in 76 (99%) patients. A second bolus of dexmedetomidine was required in 28 (36%) patients, and 22 (29%) patients required additional medications (midazolam, fentanyl, or ketamine) for adequate sedation. A 25% decrease in blood pressure (BP) was observed in 10.5%, a transient increase in BP in 3.9%, and a heart rate <60 min^?1 in 7.9% of cases. These side effects resolved spontaneously. There were no apneas or respiratory depression. Vital sign changes, recovery time, and discharge time were not significantly different in subgroups of patients receiving one or two boluses of dexmedetomidine with or without additional medications. Transient hypertension was more common in patients receiving two boluses of dexmedetomidine (P = 0.048). Conclusions: High‐dose dexmedetomidine can be successfully used for pediatric MRI sedation, but a significant number of children require additional medications for optimal control. Hemodynamic side effects resolved spontaneously. High‐dose dexmedetomidine did not result in respiratory depression.     

A comparison of dexmedetomidine sedation with and without midazolam for dental implant surgery

Dexmedetomidine (DEX) has a minimal respiratory depressive effect, which is beneficial for dentistry; however, it has the disadvantage of permitting an intraoperative arousal response such that the patient appears to be suddenly no longer sedated, and it has a variable amnestic effect. Since midazolam (MDZ) in an appropriate dose has a profound amnesic effect, we investigated whether additional MDZ compensates for the disadvantage of DEX and enables a better quality of sedation. Forty-three subjects were randomly divided into 4 groups. In group 1, MDZ (0.02 mg/kg) was administered intravenously, followed by a dose of 0.01 mg/kg every 45 minutes. After the first dose of MDZ, preloading with DEX (2 µg/kg/h for 10 minutes) was started and maintained with a dosage of 0.5 µg/kg/h. In group 2, MDZ was infused in the same manner as in group 1, followed by preloading with DEX (1 µg/kg/h for 10 minutes) and maintenance (0.3 µg/kg/h). In group 3, MDZ was infused 0.03 mg/kg, and a dose of 0.01 mg/kg was given every 30 minutes; DEX was administered at the same as in group 2. In group 4, DEX was infused using the same method as in group 1 without MDZ. The sedation levels, amnesia, and patient satisfaction were also investigated. Group 2 had a lower sedation level and a poor evaluation during the first half of the operation. Group 4 did not exhibit an amnesic effect at the beginning of the operation. An evaluation of the degree of patient satisfaction did not reveal any differences among the groups. Optimal sedation was achieved through the combined use of MDZ (0.02 mg/kg with the addition of 0.01 mg/kg every 45 minutes) and DEX (2 µg/kg/h for 10 minutes followed by 0.5 µg/kg/h).     

艾司氯胺酮复合右美托咪定滴鼻用于患儿疝囊高位结扎术前镇静的效果

目的 探讨艾司氯胺酮复合右美托咪定滴鼻用于患儿疝囊高位结扎术前镇静的安全性和有效性。
方法 选择择期行腹腔镜下疝囊高位结扎术的患儿87例,男82例,女5例,年龄1～3岁,体重9～18 kg,ASA Ⅰ或Ⅱ级。采用随机数字表法将患儿分为两组：右美托咪定组（D组,n=43）和艾司氯胺酮复合右美托咪定组（DS组,n=44）。D组采用右美托咪定2 μg/kg滴鼻,DS组采用右美托咪定2 μg/kg+艾司氯胺酮1 mg/kg滴鼻。记录滴鼻后30 min改良警觉/镇静（MOAA/S）量表评分、父母分离焦虑量表（PSAS）评分、面罩接受量表（MAS）评分。记录首次静脉穿刺成功率、镇静起效时间、补救镇静例数、术中芬太尼消耗量、苏醒时间、麻醉后监测治疗室（PACU）停留时间、术后补救镇痛例数及滴鼻后心动过缓、低血压、喉痉挛、低氧血症、术后躁动和术后呕吐的发生情况。
结果 与D组比较,DS组滴鼻后30 min MOAA/S评分、PSAS评分和MAS评分均明显降低,首次静脉穿刺成功率明显升高,镇静起效时间明显缩短,PACU停留时间明显缩短,补救镇痛率和心动过缓发生率明显降低（P<0.5）。两组术中芬太尼消耗量、苏醒时间差异无统计学意义。两组其余不良反应发生率差异无统计学意义。
结论 艾司氯胺酮复合右美托咪定滴鼻可安全有效地用于患儿疝囊高位结扎术前镇静,缩短镇静起效时间,提高首次静脉穿刺成功率且不增加不良反应。     

右美托咪定对妇科手术麻醉诱导期舒芬太尼镇痛和镇静效果的影响

目的借助压痛阈值测量和Narcotrend监测实时评价右美托咪定对妇科手术患者麻醉诱导期小剂量舒芬太尼镇痛和镇静效果的影响。方法全麻下择期行妇科手术患者100例,年龄18~65岁,ASAⅠ或Ⅱ级,随机分为右美托咪定组(D组)和对照组(C组),每组50例。D组:静脉给予1μg/kg右美托咪定(稀释到10ml)+0.4μg/kg舒芬太尼,C组:静脉给予10ml生理盐水+0.4μg/kg舒芬太尼。记录给药前(T1)、给予右美托咪定或生理盐水后(T2)、患者达最高清醒程度(T3)和给予舒芬太尼5min后(T4)时的Nacotrend指数(NTI),同时记录T3至T4期间NTI到达最低值的时间;并于T1和T4时测量探头压痛痛阈(pressure pain threshold,PPT)及耐痛阈(pressure pain tolerance,PTO)。结果与T1时比较,T2时两组NTI均明显下降(P<0.05),且D组明显低于C组(P<0.05)。T3至T4期间,D组NTI达到最低值的时间明显快于C组(P<0.01)。与T1时比较,T4时两组PPT及PTO均明显增高(P<0.05),且D组的增加幅度明显大于C组(P<0.05或P<0.01)。给予舒芬太尼后D组的RR明显慢于C组(P<0.05)。结论右美托咪定可以增强小剂量舒芬太尼的镇痛效应,也可缩短镇静作用的起效时间,或存在增加舒芬太尼呼吸抑制的风险。     

右美托咪定的药物相互作用

背景 右美托咪定(dexmedetomidinne,Dex)是一种高选择性的α2肾上腺素能受体激动剂,兼具有镇静、镇痛、降低交感神经张力等作用,同时无呼吸抑制和脑电干扰等副作用,现已广泛应用于临床.大量研究表明Dex和麻醉药物之间存在药物相互作用. 目的 综述国内外Dex和麻醉药物在药代学和药效学上的相互作用研究,为临床合理应用提供参考. 内容 探讨Dex与麻醉药物之间相互作用所产生的临床效应,如减少麻醉药物用量、减少药物副作用的发生率、稳定血流动力学等,并探讨其发生的相关机制. 趋向 随着研究的不断深入,期望Dex能在临床应用中得到更广泛的应用.     

右美托咪定和丙泊酚用于硬膜外麻醉下妇科手术患者镇静的比较

目的 比较右美托咪定(Dex)和丙泊酚用于硬膜外麻醉下妇科手术患者的镇静效果.方法 硬膜外麻醉下择期行子宫或(和)卵巢切除患者100例,随机均分成Dex组(D组)和丙泊酚组(P组),应用Ramsay镇静评分和脑电双频指数(BIS)对两组患者术中镇静效果进行观察.记录给药前(T0)、切皮前即给药后15 min(T1)、手术开始后15 min(T2)、30 min(T3)、45 min(T4)、术毕(T5)及术后1 h(T6)患者HR、MAP、BIS、Ramsay镇静评分及呼吸抑制情况.结果 T1～T5时D组BIS,MAP明显低于T0时和P组,Ramsay镇静评分低于P组,HR慢于T0时和P组(P<0.05).低血压的发生率P组明显高于D组(P<0.05).结论 Dex用于硬膜外麻醉下妇科手术患者镇静是安全和可行的.     

右美托咪定联合地佐辛在ICU机械通气患者中镇痛镇静的效果

目的观察右美托咪定联合地佐辛或芬太尼在ICU机械通气患者术后镇痛镇静的效果。方法选择2016年6~12月我院ICU机械通气患者57例,男35例,女22例,年龄18~75岁,将患者按随机数字表法分为三组:右美托咪定组(A组,n=17例)、右美托咪定联合芬太尼组(B组,n=20例)和右美托咪定联合地佐辛组(C组,n=20例)。比较三组患者一般状况、疼痛评分、用药前后MAP和HR、达理想镇痛镇静的时间、机械通气总时间等指标。结果三组一般资料、重症疼痛观察(CPOT)评分、治疗前后不同时点MAP和HR、机械通气时间差异无统计学意义,达到理想镇静镇痛的时间C组明显快于A组和B组(P0.05)。结论右美托咪定联合地佐辛较单用右美托咪定及右美托咪定联合芬太尼能更快达到理想镇静镇痛效果。     

右美托咪定不同给药方法用于腹腔镜胆囊切除术患者麻醉中的临床观察

目的 探讨右美托咪定(dexmedetomidine,DEX)不同给药方法在腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)患者麻醉中辅助镇静的安全性和可行性. 方法 100例LC患者按随机数字表法分为4组:DEX负荷剂量组(Dd组)、持续剂量组(Dc组)、负荷剂量加持续输注剂量组(Ddc组)和对照组(C组),每组25例.通过不同的给药方法观察DEX对围术期循环、呼吸指标、及苏醒和术后镇痛的影响. 结果 Dd组、Dc组患者在清醒时间及拔管时间较C组、Ddc组明显缩短,清醒时间:(8.4±2.7)、(8.4±4.3)、(11.4±5.5)、(11.2±4.5) min (P＜0.05);拔管时间:(11.1±3.4)、(10.7±4.1)、(14.1±5.4)、(14.2±6.2) min(P＜0.05);应用DEX的3组术后2h视觉模拟评分法(visual analogue scales,VAS)评分明显低于C组(1.2±0.9)、(1.6±0.8)、(1.8±0.7)、(2.5±1.3)(P＜0.05);Dd组、Dc组和Ddc组在应用DEX后血压和心率(heart rate,HR)明显降低(P＜0.05),与C组比较也明显下降(P＜0.05),但4组患者围术期循环参数均在正常范围内;Dd组、Dc组和Ddc组在麻醉维持中应用的镇痛、镇静药物的总量与C组比较明显减少(P＜0.05). 结论 应用负荷剂量、持续剂量及负荷剂量加持续剂量输注的DEX均可用于LC麻醉中的辅助镇静,既稳定循环又苏醒迅速,负荷剂量及持续剂量输注的方法更优于负荷加持续输注的方法,但仍需大样本研究加以证实.     

右美托咪定与丙泊酚麻醉诱导时的协同作用

目的评价右美托咪定和丙泊酚麻醉诱导时镇静作用的相互影响。方法择期全麻手术患者75例,男36例,女39例,年龄18～65岁,BMI 20～25kg/m~2,ASAⅠ或Ⅱ级,采用随机数字表法均分为三组,每组25例:丙泊酚组(A组)、右美托咪定组(B组)、丙泊酚复合右美托咪定组(C组),每组再根据不同药物剂量分为5个亚组,相邻两组剂量等比为1.25,采用点斜法计算ED_(50)及其95%可信区间(CI)。结果A组丙泊酚诱导剂量ED_(50)为1.25 mg/kg(95%CI 0.90～1.45mg/kg),B组右美托咪定麻醉诱导剂量ED_(50)为1.35μg/kg(95%CI 0.95～1.50μg/kg),C组丙泊酚和右美托咪定诱导剂量ED_(50)分别为0.65mg/kg(95%CI 0.50～0.90mg/kg)和0.40μg/kg(95%CI 0.34～0.65μg/kg)。等辐射分析法判定丙泊酚和右美托咪定之间在镇静效应上呈现协同作用。结论右美托咪定复合丙泊酚可以产生明显的镇静效应协同作用。     

右美托咪定对心脏瓣膜置换术患者围术期应激水平及镇静评分的影响

目的 探讨右美托咪定对心脏瓣膜置换术患者围术期应激水平及镇静评分的影响.方法 回顾性分析2019-05—2020-04间在南阳医学高等专科学校第一附属医院行心脏瓣膜置换术的78例患者的临床资料,根据麻醉方法分为全身麻醉组(对照组)和右美托咪定联合全身麻醉组(观察组),各39例.比较2组患者的基线资料.术前、术后第1天的...     

Comparative study between intravenous dexmedetomidine and clonidine as premedication in pediatric patients undergoing spinal anesthesia

Title

Comparative study between intravenous dexmedetomidine and clonidine as premedication in pediatric patients undergoing spinal anesthesia.

右美托咪定用于1岁以内先天性心脏病患儿放射学检查补救镇静的疗效分析

目的 与传统镇静药物比较,评估1岁以内(1个月～1岁)先天性心脏病(congenital heart disease,CHD)患儿放射学检查时,右美托咪定(dexmedetomidine,Dex)作为首剂口服水合氯醛镇静失败后补救用药的疗效及安全性. 方法 根据意向性治疗原则,前瞻性、随机、单盲临床随机对照试验分析2016年3月29日～6月2日于我院行心血管放射学检查且需镇静的患儿225例,采用随机均衡分组法分为3组(每组75例):A组(5 mg/kg苯巴比妥肌内注射)、B组(25 mg/kg水合氯醛口服)、C组(1 μg/kg Dex滴鼻).比较首剂口服水合氯醛失败后3组补救镇静的成功率及副作用发生情况,同时分析家属满意度,比较起效时间、苏醒时间及总镇静时间,评估给药前(T0)、给药后5 min(T1)、给药后10 min(T2)、给药后20 min(T3)、起效时(T4)、检查结束时(T5)、苏醒时(T6)患儿SpO2及HR的变化. 结果 A组、B组及C组放射学检查补救镇痛成功率分别为75.8％、83.3％、90.7％,C组与A组成功率比较,差异有统计学意义(P＜0.05).分层研究后发现,C组右向左分流型CHD患儿放射学检查成功率较A组高(P＜0.05).C组起效时间与B组比较,差异有统计学意义(P＜0.05).C组苏醒时间及总镇静时间与A组及B组比较,差异有统计学意义(P＜0.05).A组、B组及C组副作用发生率分别为3.2％、7.6％、4.0％,差异无统计学意义(P＞0.05).3组HR及SpO2变化差异无统计学意义(P＞0.05). 结论 1μg/kg Dex滴鼻可以有效用于CHD患儿放射学检查补救镇静,具有起效快,效果持久的特点,其对右向左分流的紫绀型CHD患儿镇静效果较苯巴比妥更好,且不增加CHD患儿副作用的发生率.