Erdil F, Demirbilek S, Begec Z, Ozturk E, Ulger M H, Ersoy M O
Department of Anaesthesiology and Reanimation, Inonu University, School of Medicine, Malatya, Turkey.
Anaesth Intensive Care. 2009 Jul;37(4):571-6. doi: 10.1177/0310057X0903700405.
This randomised controlled study evaluated the effects of fentanyl and dexmedetomidine on emergence characteristics of children having adenoidectomy and anaesthetised with sevoflurane. Ninety children, two to seven years of age and ASA physical status I, were studied. Children were randomly assigned to one of three groups of 30 children, with the study intervention injection given intravenously after intubation. Children in Group F received fentanyl 2.5 microg x kg(-1), children in Group D received dexmedetomidine 0.5 microG x kg(-1) and children in Group C received saline solution. Anaesthesia was induced with 50% N2O and 8% sevoflurane in O2 by mask and atracurium 0.6 mg x kg(-1) was administered for tracheal intubation. All children received paracetamol 40 mg/kg rectally one hour preoperatively and dexamethasone 0.5 mg x kg(-1) intravenously. The time to extubation was shorter in Group D than Group F. The eye-opening time was longer in Group F (16.1 +/- 5.3 minutes) than in Groups C (12.0 +/- 4.2 minutes) and D (12.7 +/- 3.2 minutes). The proportion of pain-free children in early recovery was significantly higher in Groups D (47%) and F (43%) than Group C (13%) (P < 0.05). The proportion of children with agitation scores > 3 was lower in Groups D 17% (5/30) and F 13% (4/30) than in Group C 47% (14/30) (P < 0.05). Fentanyl 2.5 microg x kg(-1) and dexmedetomidine 0.5 microg x kg(-1) had similar haemodynamic effects and emergence characteristics. Fentanyl has been safely used in children for many years. Further studies of dexmedetomidine safety and its interaction with other anaesthetic agents are required before recommending its routine use during general anaesthesia in children.
这项随机对照研究评估了芬太尼和右美托咪定对接受腺样体切除术并使用七氟醚麻醉的儿童苏醒特征的影响。研究对象为90名年龄在2至7岁、ASA身体状况为I级的儿童。儿童被随机分为三组，每组30名，在插管后静脉给予研究干预注射剂。F组儿童接受2.5微克/千克的芬太尼，D组儿童接受0.5微克/千克的右美托咪定，C组儿童接受生理盐水。通过面罩用50%氧化亚氮和8%七氟醚在氧气中诱导麻醉，并给予0.6毫克/千克的阿曲库铵用于气管插管。所有儿童在术前1小时直肠给予40毫克/千克的对乙酰氨基酚，静脉给予0.5毫克/千克的地塞米松。D组的拔管时间比F组短。F组的睁眼时间（16.1±5.3分钟）比C组（12.0±4.2分钟）和D组（12.7±3.2分钟）长。早期恢复时无痛儿童的比例在D组（47%）和F组（43%）显著高于C组（13%）（P<0.05）。躁动评分>3的儿童比例在D组17%（5/30）和F组13%（4/30）低于C组47%（14/30）（P<0.05）。2.5微克/千克的芬太尼和0.5微克/千克的右美托咪定具有相似的血流动力学效应和苏醒特征。芬太尼已在儿童中安全使用多年。在推荐其在儿童全身麻醉中常规使用之前，需要进一步研究右美托咪定的安全性及其与其他麻醉剂的相互作用。
