右美托咪定对扁桃体摘除术麻醉苏醒期躁动的影响

目的 评价右美托咪定对扁桃体摘除术患者麻醉苏醒期躁动的影响.方法 择期扁桃体摘除术患者60例,年龄12～20岁,体重35～65 kg,ASA Ⅰ或Ⅱ级,随机均分为两组.麻醉诱导后,右美托咪定组(D组)在10 min内静脉泵注右美托咪定1.0μg/kg(用生理盐水稀释至50 ml),然后以0.5μg,kg-1·h-1持续泵入至手术结束前20 min.对照组(C组)以同样方式泵注生理盐水.术中吸入异氟醚和静注丙泊酚维持麻醉.记录吸痰拔管时镇静躁动(SAS)评分及拔管后10 min的Ramsay镇静评分及VAS评分.结果 D组阿托品使用次数明显多于C组(P＜0.05).拔管时D组SAS评分明显低于C组,而Ramsay评分明显高于C组(P＜0.05).结论 右美托咪定可明显减少扁桃体摘除术患者麻醉苏醒期闻躁动的发生.     

右旋美托咪啶预防小儿腹腔镜手术苏醒期躁动的研究

目的 观察右旋美托咪啶预防全麻下小儿腹腔镜鞘状突高位结扎术和疝修补术后躁动的效果.方法 将30例腹腔镜下鞘状突高位结扎和疝修补术患儿随机分为对照组和观察组,每组15例.对照组于麻醉后手术前10 min静脉泵注生理盐水20 ml;观察组于同样时间点泵注右旋美托咪啶1 μg/kg和生理盐水稀释液20 ml.记录两组麻醉时间、手术时间、术后拔管时间和停留恢复室时间;麻醉前和苏醒期最大躁动评分和围手术期心率变化.结果 两组患儿麻醉时间、手术时间、术后拔管时间和停留PACU时间和术前躁动评分无统计学差异(P>0.05);观察组的术后躁动评分和躁动发生率低于对照组(P<0.05);两组围手术期无心动过缓发生.结论 1 μg/kg的右旋美托咪啶可以降低小儿腹腔镜手术术后躁动的发生率,且无心动过缓副作用发生.     

右美托咪定预防静吸全麻苏醒期患者躁动效果观察

目的探讨右美托咪定预防静吸全麻苏醒期患者躁动的效果。方法随机将60例静吸全麻下行择期手术的患者分为2组,各30例。手术结束后患者进恢复室。观察组:静脉输注右美托咪定0.4μg∕kg,输注时间10 min。对照组:10 min内静脉输注等容量的生理盐水。记录:(1)2组患者的自主呼吸恢复时间、拔管时间、定向力恢复时间、恢复室停留时间及躁动发生率。(2)2组患者在拔管时(T1)、拔管后5 min(T2)、拔管后10 min(T3)、拔管后20 min(T4)的RSS镇静评分。结果(1)2组患者的自主呼吸恢复时间、拔管时间、定向力恢复时间、恢复室停留时间比较,差异均无统计学意义(P0.05)。(2)观察组躁动发生率低于对照组,T1~T4各时点RSS镇静评分高于对照组,差异均有统计学意义(P0.05)。结论静吸全麻手术结束后,静脉输注右美托咪定,不延长患者的苏醒时间,可提高RSS镇静评分并降低苏醒期患者的躁动发生率。     

右美托咪定预防神经外科全麻术后躁动的临床观察

目的观察右美托咪定预防神经外科手术患者术后躁动的临床效果。方法选择神经外科全麻手术患者60例,随机均分为右美托咪定组(D组)和生理盐水组(C组)。患者手术结束前10min停用麻醉药,D组静脉泵注右美托咪定0.4μg/kg10min,C组静注等剂量的生理盐水。记录麻醉前、拔管即刻、拔管后5min血流动力学变化,并对拔管后5、30、60、120min躁动程度、镇静状态、躁动发生率进行评估。观察呼吸恢复时间、唤醒时间和拔管时间。结果与C组比较,D组拔管即刻及拔管后5min的MAP明显降低,HR明显减慢(P<0.05);与麻醉前比较,D组拔管后5min的MAP明显降低,HR明显减慢,C组拔管即刻及拔管后5min的MAP明显升高,HR明显增快(P<0.05)。D组麻醉苏醒期躁动发生率、躁动程度明显低于C组,D组VAS评分在拔管后5、30、60、120min均明显低于C组(P<0.05),Ramsay镇静评分拔管后5、30min明显高于C组(P<0.05)。结论静脉泵注0.4μg/kg右美托咪定能减轻拔管期应激反应,减少躁动,不延迟呼吸恢复时间、唤醒时间和拔管时间,可预防神经外科全麻术后躁动。     

单剂量右美托咪定与芬太尼治疗成人全麻后苏醒期躁动的比较

目的比较单剂量右美托咪定与芬太尼用于成人全身麻醉后苏醒期躁动的治疗效果。方法择期气管插管全麻下手术并发生术后躁动的患者60例,年龄38~59岁,随机分为两组:右美托咪定组(D组)和芬太尼组(F组),每组30例。D组单次静注右美托咪定0.5μg/kg,F组单次静注芬太尼1μg/kg。若经上述治疗后患者仍有躁动表现,则给予间断静脉推注丙泊酚每次1.0mg/kg,直至患者Riker躁动评分达到轻度以下。结果给予单剂量的右美托咪定处理后,D组有29例患者达到平静状态,呼之能应,无刺激后即入睡,另有1例仍有轻度躁动;经单剂量的芬太尼处理后,F组仍有4例患者躁动严重,另有4例为中度躁动,9例为轻度躁动。与F组比较,D组经首次处理后,轻度、中度、重度躁动例数明显减少(P0.05)。从用药至平息躁动的时间D组为(11±3)min,明显短于F组的(27±9)min(P0.05)。D组丙泊酚总量为(50±0)mg,明显少于F组的(270±40)mg(P0.05)。治疗期间,F组有9例(30%)轻度呼吸抑制,D组有21例(70%)发生心动过缓(P0.05)。结论右美托咪定0.5μg/kg对成人全麻后躁动的治疗效果满意,并发症轻微,优于芬太尼。     

右美托咪定对老年患者脊柱手术苏醒期躁动的影响

目的观察右美托咪定对老年患者脊柱手术后苏醒期躁动(EA)的影响。方法老年患者(年龄≥60岁)60例,随机分为右美托咪定组(D组)和对照组(C组),每组30例。麻醉诱导后D组患者持续泵注右美托咪定每小时0.4μg/kg,C组持续泵注等容量的生理盐水,手术结束时停药。入麻醉恢复室(PACU)后进行Richmond躁动镇静(RASS)评分,记录EA发生率。记录患者清醒时间、气管导管拔除时间及PACU停留时间。术后24小时记录患者对苏醒期治疗的满意度。结果 D组患者EA发生率为16.67%,C组为46.67%,两组比较差异有统计学意义(P0.05),D组患者PACU停留时间为(42.17士17.40)分钟,C组为(52.50±22.12)分钟,两组比较差异有统计学意义(P0.05)。D组患者清醒时间为(16.67±7.58)分钟,拔管时间为(21.67±7.58)分钟,C组分别为(14.40±8.47)分钟和(19.10±8.86)分钟,两组比较差异无统计学意义(P0.05)。结论右美托咪定可以有效地降低老年患者脊柱手术后EA发生率,提高患者苏醒质量。     

胃肠手术中右旋美托咪定对全麻复苏期的影响

目的 探讨全身麻醉中全程复合应用右旋美托咪定对患者复苏期拔管时间、睁眼时间和血流动力学等指标的影响.方法 90例入选患者被随机分成试验Ⅰ组（T1）、试验Ⅱ组（T2）和对照组（C）3组.试验Ⅰ组患者15 min内输注0.5 μg/kg右旋美托咪定,以0.25 μg· kg-1· h-1右旋美托咪定维持至拔管;试验Ⅱ组15 min内输注0.5 μg/kg右旋美托咪定,以0.5 μg· kg-1· h-1右旋美托咪定维持至拔管;对照组（C） 输注生理盐水.记录复苏期拔管时间、睁眼时间和血流动力学变化.结果 麻醉复苏期停止输注丙泊酚至拔出气管导管时间分别为C 组（26.6 ± 8.8）min、T1组（36.0 ± 12.9）min和T2 组（33.0 ± 7.7）min,3组间比较差异无统计学意义.停止瑞芬太尼输注到拔出气管导管时间分别为 C 组（12.4 ± 7.4） min,T1 组（17.2 ± 9.9） min和T2 组（16.1 ± 7.9） min,3组间比较无统计学差异（P 〉 0.05）.睁眼时间T1为（22.1 ± 9.5）min、T2为（37.3 ± 7.4） min,均较对照组C（13.2 ± 4.8）min明显延长（P 〈 0.05）.麻醉复苏期血压、心率变化试验组较对照组稳定,T2组尤为明显.结论 成人胃肠手术全凭静脉麻醉全程复合较大剂量（0.5 μg· kg-1· h-1）右旋美托咪定对麻醉复苏期气管拔管时间无明显影响,但可延长睁眼时间并与剂量相关;复苏期血流动力学指标更平稳.     

右旋美托咪定对脊柱侧弯矫形术患者术中唤醒的影响

目的 探讨右旋美托咪定(dexmedetomidine,Dex)对脊柱侧弯矫形术患者术中唤醒的影响. 方法 40例择期全麻下行脊柱侧弯矫形手术患者,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级.采用完全随机分组法均分为Dex组(D组)和对照组(C组)(每组20例).D组麻醉诱导前10 min给予0.8 μg/kg Dex,C组给予同等剂量的生理盐水,分别在10 min内静脉泵入,随后行常规诱导插管.术中D组使用维持剂量Dex 0.2 μg·kg-1·h-1至术毕.唤醒试验开始时两组停用麻醉维持药物(D组Dex不停用),从停用所有麻醉药物(Dex除外)到患者活动脚趾的时间定为唤醒时间,唤醒后维持药物继续使用至术毕.记录唤醒试验开始时、唤醒时患者脑电双频指数(bispectralindex,BIS)值、心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)指标,记录唤醒时间、唤醒质量评分及唤醒期间出血量. 结果 两组唤醒时间差异无统计学意义;唤醒试验开始时两组患者的MAP、HR比较差异无统计学意义;唤醒时D组患者MAP和HR分别为(79±6) mm Hg(1 mm Hg=0.133 kPa)和(80±9)次/min,低于对照组MAP(88±6)mm Hg和HR(98±7)次/min(P＜0.05);D组患者的唤醒质量要明显高于C组(P＜0.01);D组患者在唤醒期间的出血量为(269±34) ml,小于C组同时期出血量(328±50) ml(P＜0.05). 结论 Dex能明显提高脊柱侧弯矫形手术术中唤醒质量,不延长唤醒时间;并且能维持唤醒期间血流动力学稳定,减少唤醒期间出血量.     

右美托咪定对小儿腹腔镜疝修补术后苏醒期躁动的影响

【摘要】 目的 研究给予单剂量右美托咪定对小儿腹腔镜疝修补术后苏醒期躁动的影响。方法60例行腹腔镜下疝修补术、ASA为Ⅰ-Ⅱ级、年龄为1~3岁的小儿。分为3组:在麻醉诱导后,D1组(n=20)静脉注射0.3 μg/kg右美托咪定;D2组(n=20)静脉注射0.5 μg/kg的右美托咪定;C组(n=20)注射相同容量的生理盐水。静脉注射时间均为10 min。麻醉诱导使用2000~4000 μg/kg异丙酚及150~200 μg/kg顺式阿曲库铵,1~1.5 MAC七氟醚和0.2 μg·kg-1·min-1瑞芬太尼用于麻醉维持。麻醉诱导后所有小儿均静注2000 μg/kg曲马多用于防治术后镇痛。结果〓D2组术后躁动评分低于对照组(P<0.05),D1组与对照组无差别。右美托咪定组的心率低于对照组(P<0.05),其术后追加药物以加强镇静镇痛的需求也较低。三组的术后拔管时间比较无统计学意义。三组均未发生术后恶心、呕吐等不良反应。结论〓给予单剂量0.5 μg/kg的右美托咪定可以有效减少行小儿腹腔镜疝修补术后苏醒期躁动的发生率,且无明显不良反应。     

右美托咪定静脉泵注和鼻内给药两种方式对小儿口腔日间手术术后躁动的影响

目的比较右美托咪定静脉泵注和鼻内给药两种方法对七氟烷吸入麻醉下小儿口腔日间手术术后躁动的影响。方法随机纳入135例拟行口腔日间手术的患儿,年龄1~6岁,分为3组,每组45例,分别予麻醉诱导后右美托咪定1μg/kg静脉泵注(VD组)、麻醉诱导前15 min右美托咪定1μg/kg鼻内给药(ND组)或等量生理盐水对照(C组)。所有患儿采用七氟烷全凭吸入麻醉。术后每5 min进行一次躁动评分(PEDA)及疼痛评分(FLACC);记录麻醉诱导前(T0)、麻醉诱导后(T1)、手术开始时(T2)、手术结束时(T3)及苏醒时(T4)的HR、BP;记录苏醒时间、PACU停留时间及恶心呕吐、呼吸抑制、心动过缓等不良反应发生情况。结果 VD组和ND组术后躁动发生率明显低于C组(P0.01);T2和T3时VD组心率明显低于ND组和C组(P0.01),T3时ND组心率低于C组(P0.05);VD组和ND组苏醒时间长于C组(P0.01);3组患儿PACU停留时间没有差异;3组患儿最高疼痛评分没有差异。VD组有4例患儿出现心动过缓需使用阿托品治疗。3组患儿均未发生其他严重不良反应。结论右美托咪定静脉泵注和鼻内给药都能明显降低七氟烷麻醉后躁动的发生,右美托咪定鼻内给药对心率影响更小。     

不同剂量右旋美托咪啶对老年患者全麻苏醒期躁动及气管拔管反应的影响

目的观察不同剂量右旋美托咪啶对老年患者苏醒期躁动及气管拔管反应的影响。方法选择择期上腹部手术老年患者80例,随机分为对照组,右旋美托咪啶干预D1、D2和D3组各20例。手术结束前5 min对照组静脉注射0.9%氯化钠注射液20 ml;D1、D2和D3组分别单次缓慢静脉注射右旋美托咪啶0.2μg/kg、0.3μg/kg、0.4μg/kg。结果对照组苏醒拔管期间平均动脉压、心率波动显著,D1、D2、D3组较平稳;四组躁动、呛咳发生率比较,差异有统计学意义(均P<0.05);D3组苏醒时间显著长于其他三组(均P<0.05)。结论单次静脉注射右旋美托咪啶0.3μg/kg可有效降低腹部手术老年患者麻醉苏醒期躁动发生率,减少气管拔管反应而不延长气管拔管时间。     

Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery

BACKGROUND: The purpose of the present study was to determine whether prophylactic use of 1 microg x kg(-1) dexmedetomidine affected the incidence of emergence agitation (EA) after sevoflurane based anesthesia without surgery in children. METHODS: In a double-blinded trial, 42 children (ASA I-II,18 months to 10 years) undergoing magnetic resonance imaging (MRI) examination were randomly assigned to receive dexmedetomidine 1 microg x kg(-1) iv or placebo after induction of anesthesia. Heart rate (HR), mean arterial pressure (MAP), hemoglobin oxygen saturation (SpO2) were monitored. Anesthesia was induced in all patients, irrespective of group, with 8% sevoflurane in 50-50% O2/N2O and maintained with 1.5% sevoflurane in 50/50% O2/N2O. Agitation parameters were assessed with a 5-point scale and measured every 5 min. Delirium was defined as agitation score of > or =4 for > or =5 min. Anesthesia and procedure times and per- and postoperative side effects were recorded. RESULTS: The HR, MAP, and SpO2, spontaneous arm or leg motion times and purposeful movement times showed no significant differences between the two groups. The time of removing the LMA, and the time of eye opening with verbal stimuli was shorter in group P than the group D (P = 0.007 and P = 0.01). The time of discharge to recovery room and the time of discharge from hospital were similar in the two groups. The mean agitation scores in the dexmedetomidine group were significantly lower than the placebo group except at 30 min (P < 0.0001, P = 0.001, P = 0.002, P = 0.013 and P = 0.001). The incidence of emergence agitation was 47.6% in group P, and 4.8% in group D (P = 0.002). CONCLUSION: We concluded that a 1 microg x kg(-1) dose of i.v. dexmedetomidine reduces EA after sevoflurane anesthesia in children undergoing MRI.     

右旋美托咪定与丙泊酚用于腰硬联合麻醉时NTI与OAA/S镇静评分的比较

目的比较右旋美托咪定和丙泊酚对腰硬联合麻醉下手术患者术中镇静时Narcotrend麻醉指数(NTI)与警觉/镇静评分(OAA/S)的相关性。方法在腰硬联合麻醉下行择期下腹部手术或下肢手术的患者60例,ASAⅠ~Ⅱ级,分为2组,分别为右旋美托咪定组(D组,n=30)、丙泊酚组(P组,n=30)。在腰硬联合麻醉平面稳定且确保麻醉效果后,D组给予0.6、1.2、2.4 ng·mL~(-1)的右旋美托咪定,P组给予1、2、4μg·mL~(-1)的丙泊酚,每个浓度维持20 min。比较两组患者每个时刻点的OAA/S及NTI。结果丙泊酚组在OAA/S为5、4、3、2、1分时的NTI分别为96(89~97)、83(86~82)、66(63~71)、57(50~61)、46(40~50);右旋美托咪定组在OAA/S为5、4、3、2、1分时的NTI分别为94(78~98)、79(83~75)、45(45~52)、38(34~41)、24(20~30)。结论在使用丙泊酚镇静过程中,NTI与OAA/S的相关性好于右旋美托咪定;右旋美托咪定镇静时,NTI和OAA/S联合使用比单独使用NTI更能反映患者的镇静深度。     

The effect of dexmedetomidine during myringotomy and pressure-equalizing tube placement in children

Background: Bilateral myringotomy (BMT) is a commonly performed otolaryngologic procedure in children. Objectives: To examine the effects of intranasal dexmedetomidine, an α₂‐adrenoceptor agonist, on time‐averaged pain scores, pain control, need for rescue analgesia, and agitation scores in children undergoing BMT. Methods: We designed a trial to enroll 160 children randomized to one of four groups: two study groups, dexmedetomidine (1 or 2 μg·kg^?1), or two control groups representing our institutional standards of practice (intranasal fentanyl‐2 μg·kg^?1 or acetaminophen as needed postoperatively). Results: After 101 children were enrolled, patient caregivers observed that some enrollees were excessively sedated and required prolonged postanesthesia care unit (PACU) stay. This observation led to an unplanned interim analysis and early trial termination. After data were collected, severe nonnormality of pain and agitation scores necessitated a switch of the outcome to assess repeated measurements of the proportion of patients with pain, severe pain, and agitation. Demographics, time to emergence, and agitation were similar among all groups. The risk of requiring acetaminophen rescue (P < 0.0001) and proportion of patients having pain (P = 0.016) was significantly higher in one control group (rescue analgesia only) compared with fentanyl or dexmedetomidine groups. Importantly, length of stay in the PACU was significantly longer in dexmedetomidine‐2 μg·kg^?1‐treated compared with dexmedetomidine‐1 μg·kg^?1‐treated, fentanyl‐treated, or the control group, P = 0.0037. Conclusions: In this trial, we were unable to answer the original question as to the role of dexmedetomidine on time‐averaged pain and agitation scores after BMT. However, our findings clearly demonstrate that in children undergoing BMT, at higher doses, dexmedetomidine significantly prolongs length of stay in the PACU.     

Changes in the EEG power spectrum after midazolam anaesthesia combined with racemic or S – (+) ketamine

Changes in the EEG power spectrum were studied in 50 patients (ASA status I or II), receiving either 2 mg·kg^-1 of racemic ketamine or 1 mg kg^-1 of S – (+) ketamine in a randomized and double-blind manner after prior administration of 0.1 mg·kg^-1 of midazolam. The patients receiving intramuscular premedication with midazolam about 45 minutes prior to induction of anaesthesia showed, in a deliberately quiet environment and mostly in the early morning, a delta dominated EEG (56% delta power) with a reduced alpha peak (17% alpha power) and an average median of 4 Hz as the baseline findings of the EEG power spectrum. The intravenous administration of midazolam led to activation of the lower beta range (13–18 Hz) and the subsequent injection of ketamine caused an increase in activity in the fast beta range (21–30 Hz), both being accompanied by a reduction of delta power from 56% to 40%. Correspondingly, an increase in the median frequency was noted. Causing nearly the same changes in EEG, S – (+) ketamine was confirmed to be twice as potent as racemic ketamine.     

Emergence agitation in paediatric patients after sevoflurane anaesthesia and no surgery: a comparison with halothane

This study was designed to compare the emergence characteristics of sevoflurane with halothane anaesthesia in paediatric patients having no surgical intervention. We randomized 32 ASA I or II paediatric outpatients scheduled for magnetic resonance imaging scans to receive either halothane or sevoflurane anaesthesia. The primary outcome measure was the percentage of patients with emergence agitation, as defined by two different criteria. Time to discharge from the postanaesthesia care unit (PACU) and the secondary recovery unit (SRU) were compared. Sevoflurane patients had a greater incidence of emergence delirium when a high threshold for agitation was defined (33% vs. 0%, P = 0.010) and a lower threshold for agitation was applied (80% vs. 12%, P<0.0001). Discharge times from the PACU and the SRU were not different. We conclude that there is an increased incidence of emergence agitation with sevoflurane anaesthesia compared to halothane independent of any painful stimulus.