Department of Anesthesiology, University of Missouri, Columbia, MO 65212, USA.
J Clin Anesth. 2010 Nov;22(7):538-45. doi: 10.1016/j.jclinane.2010.03.002.
To evaluate the combination of dexmedetomidine and ketamine for sedation during lumbar puncture and sedation for spinal anesthesia in children.
Retrospective analysis of quality assurance data sheets and anesthetic records.
Developing countries with the humanitarian group, Kids First.
12 infants and children, ranging in age from two to 9 years.
A bolus dose of ketamine (two mg/kg) and dexmedetomidine (one μg/kg) was given over three minutes followed by a continuous infusion of dexmedetomidine (two μg/kg/hr for the first 30 min, followed by one μg/kg/hr for the duration of the case). Supplemental analgesia/sedation was provided by ketamine (0.5 mg/kg) as needed.
The need for supplemental ketamine, the ability to complete the procedure, and heart rate (HR), blood pressure, end-tidal carbon dioxide (ETCO(2)), and oxygen saturation values were recorded.
Effective sedation for lumbar puncture and performance of spinal anesthesia were achieved in all patients. One patient required a supplemental dose of ketamine (0.5 mg/kg). Following the bolus dose of ketamine and dexmedetomidine, HR increased by 11 ± 4 bpm. The greatest HR increase was 20 bpm. No patient had a HR increase ≥ 20% from baseline. The HR decrease was ≤ 30 bpm in 10 of the 12 patients, and the greatest HR decrease was 58 bpm. Systolic blood pressure (SBP) increased from baseline by 10 ± 3 mmHg after administration of the bolus dose of ketamine and dexmedetomidine. During the subsequent dexmedetomidine infusion, SBP decreased by 11 ± 9 mmHg. No patient's respiratory rate decreased to less than 10 breaths/min or increased above 24 breaths/min during the procedural sedation. The highest ETCO(2) was 45 ± 2 mmHg (P < 0.0001). Oxygen saturation remained ≥ 95% during the procedure in all patients.
A combination of ketamine and dexmedetomidine provides effective sedation during spinal anesthesia in infants and children, with limited effects on cardiovascular and ventilatory function.
评估右美托咪定和氯胺酮联合镇静在小儿腰椎穿刺中的镇静效果，以及在脊髓麻醉中的镇静效果。
质量保证数据单和麻醉记录的回顾性分析。
发展中国家的人道主义组织 Kids First。
12 名年龄在 2 至 9 岁的婴儿和儿童。
静脉推注氯胺酮（2mg/kg）和右美托咪定（1μg/kg），持续 3 分钟，然后持续输注右美托咪定（前 30 分钟 2μg/kg/hr，然后在整个手术过程中 1μg/kg/hr）。根据需要给予氯胺酮（0.5mg/kg）作为辅助镇痛/镇静药物。
记录需要补充氯胺酮的次数、完成手术的能力以及心率（HR）、血压、呼气末二氧化碳（ETCO2）和血氧饱和度值。
所有患者均实现了腰椎穿刺的有效镇静和脊髓麻醉的顺利进行。一名患者需要补充氯胺酮（0.5mg/kg）。静脉推注氯胺酮和右美托咪定后，HR 增加 11±4bpm。最大 HR 增加为 20bpm。没有患者的 HR 增加超过基线的 20%。在 12 名患者中有 10 名患者的 HR 下降≤30bpm，最大 HR 下降为 58bpm。静脉推注氯胺酮和右美托咪定后，收缩压（SBP）比基线增加 10±3mmHg。在随后的右美托咪定输注过程中，SBP 下降 11±9mmHg。在整个镇静过程中，没有患者的呼吸频率下降到每分钟 10 次以下或增加到每分钟 24 次以上。最高 ETCO2 为 45±2mmHg（P<0.0001）。在所有患者中，氧饱和度在手术过程中均保持在 95%以上。
氯胺酮和右美托咪定联合使用可为婴儿和儿童的脊髓麻醉提供有效的镇静效果，对心血管和呼吸功能的影响有限。
