Heard Christopher, Burrows Frederick, Johnson Kristin, Joshi Prashant, Houck James, Lerman Jerrold
Department of Anesthesiology and Division of Pediatric Critical Care, State University of New York at Buffalo, Women and Children's Hospital of Buffalo, Buffalo, New York 14222, USA.
Anesth Analg. 2008 Dec;107(6):1832-9. doi: 10.1213/ane.0b013e31818874ee.
Dexmedetomidine is an alpha(2) agonist that is currently being investigated for its suitability to provide anesthesia for children. We compared the pharmacodynamic responses to dexmedetomidine-midazolam and propofol in children anesthetized with sevoflurane undergoing magnetic resonance imaging (MRI).
Forty ASA 1 or 2 children, 1-10 yr of age, were randomized to receive either dexmedetomidine-midazolam or propofol for maintenance of anesthesia for MRI after a sevoflurane induction. Dexmedetomidine was administered as an initial loading dose (1 microg/kg) followed by a continuous infusion (0.5 microg x kg(-1) x h(-1)). Midazolam (0.1 mg/kg) was administered i.v. when the infusion commenced. Propofol was administered as a continuous infusion (250-300 microg x kg(-1) x min(-1)). Recovery times and hemodynamic responses were recorded by one nurse who was blinded to the treatments.
We found that the times to fully recover and to discharge from the ambulatory unit after dexmedetomidine administration were significantly greater (by 15 min) than those after propofol. Analysis of variance demonstrated that heart rate was slower and systolic blood pressure was greater with dexmedetomidine than propofol. Respiratory indices for the two treatments were similar. During recovery, hemodynamic responses were similar. Cardiorespiratory indices during anesthesia and recovery remained within normal limits for the children's ages. No adverse events were recorded.
Dexmedetomidine-midazolam provides adequate anesthesia for MRI although recovery is prolonged when compared with propofol. Heart rate was slower and systolic blood pressure was greater with dexmedetomidine when compared with propofol. Respiratory indices were similar for the two treatments.
右美托咪定是一种α₂激动剂，目前正在研究其用于小儿麻醉的适用性。我们比较了接受七氟醚麻醉进行磁共振成像（MRI）的儿童对右美托咪定-咪达唑仑和丙泊酚的药效学反应。
40例年龄1至10岁、美国麻醉医师协会（ASA）分级为1或2级的儿童，在七氟醚诱导麻醉后，随机接受右美托咪定-咪达唑仑或丙泊酚维持MRI麻醉。右美托咪定先给予初始负荷剂量（1μg/kg），然后持续输注（0.5μg·kg⁻¹·h⁻¹）。输注开始时静脉注射咪达唑仑（0.1mg/kg）。丙泊酚持续输注（250 - 300μg·kg⁻¹·min⁻¹）。由一名对治疗方案不知情的护士记录恢复时间和血流动力学反应。
我们发现，给予右美托咪定后完全恢复和从门诊单元出院的时间比给予丙泊酚后显著延长（延长15分钟）。方差分析表明，与丙泊酚相比，右美托咪定使心率减慢、收缩压升高。两种治疗的呼吸指标相似。恢复期间，血流动力学反应相似。麻醉和恢复期间的心肺指标保持在儿童年龄的正常范围内。未记录到不良事件。
右美托咪定-咪达唑仑可为MRI提供充分麻醉，尽管与丙泊酚相比恢复时间延长。与丙泊酚相比，右美托咪定使心率减慢、收缩压升高。两种治疗的呼吸指标相似。
