Department of Anaesthesiology (ARA), Faculty of Medicine, Cairo University, Cairo, Egypt.
Eur J Anaesthesiol. 2010 Dec;27(12):1058-64. doi: 10.1097/EJA.0b013e32833e6e2d.
the present study was designed to compare the efficacy, tolerability and safety of dexmedetomidine and fentanyl when combined with propofol during extracorporeal shock wave lithotripsy in children.
fifty children aged 3-8 years, the American Society of Anesthesiologists status I and II, scheduled for elective extracorporeal shock wave lithotripsy were randomly allocated to receive a loading dose 0.7 μg kg over 10 min followed by maintenance infusion 0.3 μg kg h of either dexmedetomidine in propofol/dexmedetomidine group or fentanyl in propofol/fentanyl group (n = 25 each). The target drug infusion rates were adjusted to keep the haemodynamics within ± 20% from the baseline values. All patients received propofol infusion to maintain bispectral index values (40-60) throughout the procedure. Induction and maintenance doses of propofol were recorded. Total doses of both studied drugs were calculated. Perioperative haemodynamics, incidence of intraprocedural and postprocedural complications and time to first analgesic requirement were recorded.
the propofol requirement was significantly lower in the propofol/dexmedetomidine group than that in propofol/fentanyl group during induction and maintenance of anaesthesia (P < 0.0001). Total doses of fentanyl and dexmedetomidine were 0.961 (0.1) μg kg and 0.925 (0.07) μg kg, respectively. Mean arterial pressure and heart rate were significantly decreased compared to the baseline throughout the procedure in both groups and increased significantly relative to both baseline and the other group at 30 min in the propofol/fentanyl group and 60 min in the propofol/dexmedetomidine group in the recovery area (P < 0.05). In propofol/dexmedetomidine group, the incidence of intraprocedural hypoventilation was significantly lower (P = 0.016) and time to first analgesic requirement was significantly longer (P < 0.0001) than that in propofol/fentanyl group.
both propofol/fentanyl and propofol/dexmedetomidine combinations at mentioned dose regimen were effective and well tolerated for children undergoing extracorporeal shock wave lithotripsy. However, propofol/dexmedetomidine combination was accompanied with less propofol consumption, prolonged analgesia and lower incidence of intraprocedural and postprocedural complications.
本研究旨在比较右美托咪定和芬太尼联合丙泊酚在儿童体外冲击波碎石术中的疗效、耐受性和安全性。
选择美国麻醉医师协会（ASA）分级 I 或 II 级，择期行体外冲击波碎石术的 50 例 3-8 岁患儿，随机分为右美托咪定/丙泊酚组（n = 25）和芬太尼/丙泊酚组（n = 25）。右美托咪定/丙泊酚组以 0.7 μg·kg -1 负荷剂量输注 10 min，随后以 0.3 μg·kg -1 ·h -1 的速度维持输注；芬太尼/丙泊酚组以 2 μg·kg -1 负荷剂量输注 10 min，随后以 2 μg·kg -1 ·h -1 的速度维持输注。两组患儿均以丙泊酚输注维持脑电双频指数值（40-60）。记录诱导和维持麻醉期间丙泊酚的用量，计算两种研究药物的总剂量。记录围术期血流动力学变化、术中及术后并发症的发生情况及首次镇痛需求时间。
与芬太尼/丙泊酚组相比，右美托咪定/丙泊酚组在麻醉诱导和维持期间丙泊酚的用量显著降低（P < 0.0001）。芬太尼和右美托咪定的总剂量分别为 0.961（0.1）μg·kg -1 和 0.925（0.07）μg·kg -1 。与基础值相比，两组患儿在整个手术过程中的平均动脉压和心率均显著降低，与基础值和同组 30 min 时相比，丙泊酚/芬太尼组在恢复区的心率显著升高，而右美托咪定/丙泊酚组在恢复区的心率在 60 min 时显著升高（P < 0.05）。与芬太尼/丙泊酚组相比，右美托咪定/丙泊酚组术中低通气的发生率显著降低（P = 0.016），首次镇痛需求时间显著延长（P < 0.0001）。
在本研究剂量方案下，右美托咪定/丙泊酚和芬太尼/丙泊酚联合应用均能有效、耐受地用于儿童体外冲击波碎石术。然而，与芬太尼/丙泊酚组相比，右美托咪定/丙泊酚组丙泊酚消耗减少，镇痛时间延长，术中及术后并发症发生率降低。
