不同剂量右旋美托咪啶对七氟醚吸入麻醉诱导的影响

目的:观察不同剂量右旋美托咪啶对七氟醚吸入麻醉诱导和气管插管过程中血流动力学和脑电双频指数(BIS)的影响。方法:选择择期妇科腹腔镜手术全麻患者45例,随机分为3组,每组15例,A组为单纯吸入七氟醚麻醉诱导组,B组和C组为吸入七氟醚麻醉诱导前分别静脉泵注右旋美托咪啶0.5μg/kg和1.0μg/kg组,观察3组患者的血流动力学和BIS的变化,并记录患者入睡时间、BIS值达到60时间、可以实施气管插管时间、手术和麻醉时间、入睡前实施肺活量次数和整个过程发生的不良反应事件。结果:与麻醉诱导前(T0)相比,麻醉后插管前(T1)血压、心率和BIS明显下降(P<0.05),围插管期(T2)A组血压较诱导前插管前增高(P<0.05);与A组相比,围诱导期(T1和T2)B组和C组血压、心率和BIS值较低(P<0.05),围拔管期(T3)B组和C组血压和心率较诱导前增加较低(P<0.05);与A组相比,B组和C组患者的意识消失时间、BIS值小于或等于60时间、气管插管时间较短(P<0.05),以C组缩短明显;B组和C组吸入过程中N次肺活量较A组少。结论:右旋美托咪啶0.5、1.0μg/kg均可产生明显镇静效应,缩短诱导时间;抑制七氟醚吸入诱导气管插管时的应激反应,以右旋美托咪啶1.0μg/kg的作用更理想,但要注意防止围麻醉期出现的严重心动过缓和低血压。

Effects of different doses of dexmedetomidine during induction anesthesia with sevoflurane inhalation

AIM: To evaluate the effects of two single preanesthetic doses of dexmedetomidine(0.5 μg/kg and 1.0 μg/kg) on bispectral index(BIS) and hemodynamic changes undergoing endotracheal intubation under induction anesthetic with sevoflurane inhalation.METHODS: In a double-blind and random study,45 patients scheduled for gynaecologic laparoscopy operation were divided into 3 groups(n=15 for each).Patients in Group A were anesthetized with inhalation of sevoflurance;Patients in Group B and Group C were anesthetized with 0.5 μg/kg and 1.0 μg/kg dexmedetomidine infusion before anesthetic induction with sevoflurane in oxygen by face mask.The changes in hemodynamics and BIS were observed at time points before induction(T0),after induction(T1),and 5 min(T2) after intubation.Time going into sleep,time for the BIS to 60,time carrying intubation,anesthesia and operation,times carrying vital capacity breath,and the adverse effect were also observed. RESULTS:Compared with the values at T0,the BIS,the heart rate and blood pressure were decreased remarkably at T1(P<0.05).At T2,the blood pressure was significantly higher than those at T0 and T1 in Group A(P<0.05).Compared with Group A,the BIS,heart rate and blood pressure were lower in Groups B and C(P<0.05)at T1,T2.The time going into sleep,time for the BIS to 60 and time carrying intubation were shorter in Group B and C(P<0.05),especially in group C. CONCLUSION: Both dexmedetomidine 0.5 μg/kg and 1.0 μg/kg caused sedation and significantly decreased hemodynamics and stress reaction to endotracheal intubation during sevoflurane anesthesia induction.Dexmedetomidine 1.0 μg/kg was better than dexmedetomidine 0.5 μg/kg.Severe bradycardia and hypotension during anesthesia should be noticed.