Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, 1981, Tsujido-cho, Kamoda, Kawagoe, Saitama, 350-8550, Japan.
J Anesth. 2010 Feb;24(1):49-53. doi: 10.1007/s00540-009-0863-z.
The objective of this study was to evaluate the efficacy and safety of buccal dexmedetomidine as a preanesthetic in children, to compare it with diazepam, and to investigate the optimal dosage for buccal dexmedetomidine administration by measuring its serum concentration.
We performed a prospective study with 40 children who were assigned to two groups. The patients underwent an operation for inguinal or umbilical hernia. Twenty children received dexmedetomidine buccally at 3-4 microg/kg (Dex Group) and 20 received a diazepam suppository at 0.7 mg/kg (Diazepam Group) as preanesthetics 1 h before the operation. Heart rate, systolic blood pressure, SpO2, and respiratory rate were measured 1 h after premedication in all children. Sedation level was preoperatively evaluated, and compared with the Ramsay score, in the ward, at the entrance to the main operating rooms, and at anesthesia induction between the two groups. To investigate the optimal dosage of buccal dexmedetomidine, we compared the mean serum concentration of dexmedetomidine at induction between patients with a Ramsay score of 5 or greater and those with a Ramsay score less than 5. The Mann-Whitney U test was used for statistical analysis.
There was no significant difference between the two groups in age or body weight. Furthermore, there was no significant difference between the two groups in heart rate, systolic blood pressure, SpO2, or respiratory rate after administration of either medication. The Ramsay score of the Dex Group was significantly higher than that of the Diazepam Group at all times. The mean serum dexmedetomidine concentration at induction in patients with a Ramsay score of 5 or greater (75 +/- 50 pg/ml) was significantly higher than in those with a Ramsay score less than 5 (34 +/- 36 pg/ml, P < 0.05).
These results suggest that the buccal administration of dexmedetomidine (3-4 microg/kg) 1 h before the operation can be safely and effectively applied as a preanesthetic in children.
本研究旨在评估口腔给予右美托咪定作为小儿术前用药的疗效和安全性，与地西泮比较，并通过测量其血清浓度来探讨口腔给予右美托咪定的最佳剂量。
我们进行了一项前瞻性研究，共纳入 40 名接受腹股沟或脐疝手术的患儿，将其分为两组。20 名患儿接受 3-4μg/kg 口腔给予右美托咪定（Dex 组），20 名患儿接受 0.7mg/kg 地西泮栓剂（Diazepam 组）作为术前用药，在手术前 1 小时给予。所有患儿在术前 1 小时测量心率、收缩压、SpO2 和呼吸频率。在病房、主手术室入口和麻醉诱导时评估镇静水平，并与两组的 Ramsay 评分进行比较。为了探讨口腔给予右美托咪定的最佳剂量，我们比较了 Ramsay 评分≥5 分和 Ramsay 评分<5 分的患者在诱导时右美托咪定的平均血清浓度。采用 Mann-Whitney U 检验进行统计学分析。
两组患儿的年龄和体重无显著差异。此外，两组患儿在给予任何药物后心率、收缩压、SpO2 或呼吸频率均无显著差异。Dex 组的 Ramsay 评分在所有时间点均显著高于 Diazepam 组。Ramsay 评分≥5 分的患者在诱导时的右美托咪定平均血清浓度（75±50pg/ml）显著高于 Ramsay 评分<5 分的患者（34±36pg/ml，P<0.05）。
这些结果表明，手术前 1 小时口腔给予右美托咪定（3-4μg/kg）可安全有效地作为小儿术前用药。
