Ohtani Norimasa, Kida Kotaro, Shoji Kazuhiro, Yasui Yutaka, Masaki Eiji
Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai 980-8574, Japan.
Anesth Analg. 2008 Dec;107(6):1871-4. doi: 10.1213/ane.0b013e3181887fcc.
Dexmedetomidine induces less change in hemodynamic values during the extubation period. This drug may be useful in anesthetic management requiring smooth emergence from anesthesia. We sought to determine the effects of co-administration of dexmedetomidine on the recovery profiles from sevoflurane and propofol, which usually provide safe and rapid recovery when administered alone.
Sixty patients undergoing lower abdominal surgery were randomly divided into four groups according to the anesthetic to be administered; namely, sevoflurane (group S), propofol (group P), both sevoflurane and dexmedetomidine (group SD), or propofol and dexmedetomidine (group PD) as maintenance general anesthetics. After induction, anesthesia was maintained with sevoflurane (0.6%-1.5%) in group S, propofol (2-5 mg/kg/h) in group P, sevoflurane and dexmedetomidine (1 microg/kg over 10 min followed by 0.4 microg/kg/h until the end of surgery) in group SD, and propofol and dexmedetomidine in group PD with continuous epidural infusion. Bispectral Index values were maintained within 45 +/- 5 by changing the concentration of sevoflurane or the infusion rate of propofol in all groups. The time between the interruption of maintenance general anesthetics and eye opening was measured. Postoperative cognitive function was evaluated using the Short Orientation Memory Concentration Test.
The time to eye opening of groups S (8.5 +/- 2.5 min, mean +/- SD; n = 15) and SD (12.0 +/- 3.3 min) were comparable, whereas that of group PD (21.7 +/- 7.1 min) was longer than that of group P (11.0 +/- 4.4 min). The time to eye opening of group PD was significantly (P < 0.001) longer than those of the other three groups. The scores of Short Orientation Memory Concentration Test between groups S and P were similar and were not changed by co-administration of dexmedetomidine.
When co-administered with dexmedetomidine, sevoflurane produced a shorter time to eye opening than propofol. Postoperative cognitive function was not affected by dexmedetomidine administration. These results suggest dexmedetomidine may delay recovery when given as an adjuvant to propofol during total i.v. anesthesia.
右美托咪定在拔管期间引起的血流动力学值变化较小。这种药物可能有助于需要平稳从麻醉中苏醒的麻醉管理。我们试图确定右美托咪定联合给药对七氟醚和丙泊酚苏醒情况的影响，七氟醚和丙泊酚单独使用时通常能提供安全且快速的苏醒。
60例接受下腹部手术的患者根据所使用的麻醉药物随机分为四组；即七氟醚组（S组）、丙泊酚组（P组）、七氟醚和右美托咪定联合组（SD组）或丙泊酚和右美托咪定联合组（PD组）作为维持全身麻醉用药。诱导后，S组用七氟醚（0.6%-1.5%）维持麻醉，P组用丙泊酚（2-5mg/kg/h）维持麻醉，SD组用七氟醚和右美托咪定（1μg/kg持续10分钟，随后0.4μg/kg/h直至手术结束）维持麻醉，PD组用丙泊酚和右美托咪定并持续硬膜外输注。通过改变七氟醚浓度或丙泊酚输注速率使所有组的脑电双频指数值维持在45±5。测量维持全身麻醉中断至睁眼的时间。使用简易定向记忆注意力测试评估术后认知功能。
S组（8.5±2.5分钟，均值±标准差；n = 15）和SD组（12.0±3.3分钟）的睁眼时间相当，而PD组（21.7±7.1分钟）的睁眼时间长于P组（11.0±4.4分钟）。PD组的睁眼时间显著长于其他三组（P < 0.001）。S组和P组的简易定向记忆注意力测试得分相似，且右美托咪定联合给药未使其改变。
与右美托咪定联合使用时，七氟醚组的睁眼时间短于丙泊酚组。右美托咪定给药不影响术后认知功能。这些结果表明，在全静脉麻醉期间，右美托咪定作为丙泊酚的辅助用药时可能会延迟苏醒。
