Eren Gulay, Cukurova Zafer, Demir Guray, Hergunsel Oya, Kozanhan Betul, Emir Nalan S
Department of Anaesthesiology and Intensive Care, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
J Anaesthesiol Clin Pharmacol. 2011 Jul;27(3):367-72. doi: 10.4103/0970-9185.83684.
This study was conducted to compare the efficacy and effects of dexmedetomidine and midazolam in preoperative sedation.
A total of 125 patients in American Society of Anaesthesiologists (ASA) I-II were divided into three groups: Group I (n = 40) for controls, Group II (n = 40) for Dexmedetomidine (1 μg/kg), and group III was the midazolam group (n = 45). Group III was further divided into three subgroups according to the doses of midazolam: Group IIIA (n = 15) received 0.02 mg/kg, group IIIB (n = 15) received 0.04 mg/kg, and group IIIC (n = 15) received 0.06 mg/kg of midazolam. Drugs were infused over a 10-minute period with appropriate monitoring. Ramsay and visual analog scores, for sedation and anxiety, respectively, and mean arterial pressure, heart rate, and SpO(2) measurement, including respiratory rates were recorded, every 5 minutes for 30 minutes following infusion.
There was marked sedation and a decrease in anxiety in groups II and IIIC (P < 0.01). Mean arterial pressure (MAP) and heart rate (HR) decreased significantly in group II (P < 0.01 and P < 0.05, respectively), but there was no associated hypotension (MAP <60 mm Hg) or bradycardia (HR <50 bpm) (P < 0.05). Respiratory rates and SpO(2) values decreased in groups II, IIIA, IIIB, and IIIC. The differences in respiratory rates were not significant (P > 0.05); however, decrease in SpO(2) was significant in group IIIC (P < 0.01).
Dexmedetomidine was as effective as higher doses of midazolam in sedation. The hemodynamic and respiratory effects were minimal. Although dexmedetomidine caused significant decrease in the blood pressure and heart rate, it probably just normalized increased levels caused by preoperative stress.
本研究旨在比较右美托咪定和咪达唑仑在术前镇静中的疗效和效果。
总共125例美国麻醉医师协会（ASA）分级为I-II级的患者被分为三组：I组（n = 40）为对照组，II组（n = 40）为右美托咪定组（1μg/kg），III组为咪达唑仑组（n = 45）。III组根据咪达唑仑剂量进一步分为三个亚组：IIIA组（n = 15）接受0.02mg/kg，IIIB组（n = 15）接受0.04mg/kg, IIIC组（n = 15）接受0.06mg/kg的咪达唑仑。药物在10分钟内输注，并进行适当监测。分别记录输注后30分钟内每隔5分钟的Ramsay评分和视觉模拟评分，用于评估镇静和焦虑程度，以及平均动脉压、心率和SpO₂测量值，包括呼吸频率。
II组和IIIC组有明显的镇静作用且焦虑程度降低（P < 0.01）。II组的平均动脉压（MAP）和心率（HR）显著降低（分别为P < 0.01和P < 0.05）, 但未出现相关的低血压（MAP < 60mmHg）或心动过缓（HR < 50bpm）（P < 0.05）。II组、IIIA组、IIIB组和IIIC组的呼吸频率和SpO₂值降低。呼吸频率差异无统计学意义（P > 0.05）；然而，IIIC组SpO₂的降低具有统计学意义（P < 0.01）。
右美托咪定在镇静方面与高剂量咪达唑仑效果相当。对血流动力学和呼吸的影响最小。尽管右美托咪定导致血压和心率显著降低，但可能只是使术前应激引起的升高水平恢复正常。
