Schmidt André P, Valinetti Emilia A, Bandeira Denise, Bertacchi Maria F, Simões Cláudia M, Auler José Otávio C
Division of Anesthesiology and Children's Institute, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
Paediatr Anaesth. 2007 Jul;17(7):667-74. doi: 10.1111/j.1460-9592.2006.02185.x.
A growing interest in the possible influences of pre- and postoperative anxiety and pain scores as outcomes of surgical treatment and benefits of anxiety or pain-reducing interventions has emerged. The aim of this study was to evaluate the influence of three different premedication regimens on postoperative pain and anxiety in children.
A prospective, randomized, open-label clinical trial enrolled 60 schoolchildren. They were randomized for premedication with oral midazolam 0.5 mgxkg(-1), oral clonidine 4 microgxkg(-1), or transmucosal dexmedetomidine (DEX) 1 mug.kg(-1), submitted to a pre- and postoperative evaluation of anxiety with the State-Trait Anxiety Inventory for Children and asked to report any pain in verbal and visual analog scales. We also evaluated secondary outcomes such as parents' anxiety, sedation, separation from parents, adverse effects and hemodynamic status.
Dexmedetomidine and clonidine were related to lower scores of pain than midazolam. alpha(2)-agonists produced lower scores of peroperative mean arterial pressure and heart rate than midazolam. Both groups had similar levels of postoperative state-anxiety in children. There was no difference in preanesthesia levels of sedation and response to separation from parents between groups.
These findings indicate that children receiving clonidine or DEX preoperatively have similar levels of anxiety and sedation postoperatively as those receiving midazolam. However, children given alpha(2)-agonists had less perioperative sympathetic stimulation and less postoperative pain than those given midazolam.
对于术前和术后焦虑及疼痛评分作为手术治疗结果的可能影响以及焦虑或减轻疼痛干预措施的益处，人们的兴趣与日俱增。本研究的目的是评估三种不同的术前用药方案对儿童术后疼痛和焦虑的影响。
一项前瞻性、随机、开放标签的临床试验纳入了60名学童。他们被随机分为接受口服咪达唑仑0.5mg/kg、口服可乐定4μg/kg或经黏膜右美托咪定（DEX）1μg/kg进行术前用药，采用儿童状态-特质焦虑量表对其进行术前和术后焦虑评估，并要求他们用言语和视觉模拟量表报告任何疼痛情况。我们还评估了次要结果，如父母的焦虑、镇静情况、与父母分离情况、不良反应和血流动力学状态。
与咪达唑仑相比，右美托咪定和可乐定与较低的疼痛评分相关。α2激动剂产生的术中平均动脉压和心率评分低于咪达唑仑。两组儿童术后状态焦虑水平相似。各组之间在麻醉前的镇静水平和对与父母分离的反应方面没有差异。
这些发现表明，术前接受可乐定或DEX的儿童术后焦虑和镇静水平与接受咪达唑仑的儿童相似。然而，给予α2激动剂的儿童围手术期交感神经刺激较少，术后疼痛也比给予咪达唑仑的儿童少。
