Apan A, Doganci N, Ergan A, Büyükkoçak U
Department of Anesthesiology, Kirikkale University Faculty of Medicine, Kirikkale, Turkey.
Minerva Anestesiol. 2009 May;75(5):239-44. Epub 2008 Dec 17.
This study aimed to evaluate the role of alfa-2 agonist infusion, with dexmedetomidine or midazolam, on hemodynamic and respiratory parameters while titrating the sedation level with the bispectral index (BIS) during cataract surgery.
Ninety consenting ASA class I-III patients who were electively undergoing cataract surgery were enrolled in the double blind study. A random infusion of 0.25 microg kg(-1) hr(-1) Dexmedetomidine (Group D), 25 microg kg(-1) hr(-1) midazolam (Group M), or saline for controls (Group C) was administered after mounting a BIS monitor and routine anesthetic care. The target BIS level was >85. An additional bolus dose in 1 mL increments of the study drug or cessation of the infusion was adjusted according to the BIS level. Changes in respiratory and vital parameters were noted and, in case of mild pain, 25 microg fentanyl was administered as a bolus. Pain and sedation were evaluated in the early postoperative period using visual analogue and four rating sedation scales.
In Group D, heart rate decreased in the later periods of surgery (35-50 min) and in the early postoperative period (5(th) and 15(th) min). Dose adjustments were required in six and ten patients in Groups D and M, respectively. Pain scores were lower with dexmedetomidine infusion.
Dexmedetomidine infusion mildly decreased heart rate in the later periods of surgery with better pain scores in the postoperative period. Dexmedetomidine should be an alternative for intraoperative sedation in outpatient cataract surgery.
本研究旨在评估在白内障手术期间使用右美托咪定或咪达唑仑输注α-2激动剂，并通过脑电双频指数（BIS）滴定镇静水平时，其对血流动力学和呼吸参数的作用。
90例自愿接受白内障手术的美国麻醉医师协会（ASA）I-III级患者纳入双盲研究。在安装BIS监测仪并进行常规麻醉护理后，随机输注0.25μg·kg⁻¹·hr⁻¹右美托咪定（D组）、25μg·kg⁻¹·hr⁻¹咪达唑仑（M组）或生理盐水作为对照（C组）。目标BIS水平>85。根据BIS水平，以1mL增量调整研究药物的额外推注剂量或停止输注。记录呼吸和生命体征参数的变化，若出现轻度疼痛，则推注25μg芬太尼。术后早期使用视觉模拟评分和四种镇静评分量表评估疼痛和镇静情况。
D组在手术后期（35 - 50分钟）和术后早期（第5和15分钟）心率下降。D组和M组分别有6例和10例患者需要调整剂量。输注右美托咪定的疼痛评分更低。
输注右美托咪定在手术后期轻度降低心率，术后疼痛评分更佳。右美托咪定应可作为门诊白内障手术术中镇静的一种选择。
