Keniya Varshali M, Ladi Sushma, Naphade Ramesh
Department of Anesthesia, Bharati Vidyapeeth University Medical College, Pune, Maharashtra, India.
Indian J Anaesth. 2011 Jul;55(4):352-7. doi: 10.4103/0019-5049.84846.
Dexmedetomidine, an α-2 adrenoreceptor agonist, is gaining popularity for its sympatholytic, sedative, anaesthetic sparing and haemodynamic stabilising properties without significant respiratory depression.
We assessed the efficacy of dexmedetomidine in attenuating sympathoadrenal response to tracheal intubation and analysed reduction in intraoperative anaesthetic requirement. Sixty patients scheduled for elective surgery of more than 3 hours were randomly selected. Control group received isoflurane-opioid and study group received isoflurane-opioid-dexmedetomidine anaesthesia. Dexmedetomidine infusion in a dose of 1 μg/kg was given over 10 min before the induction of anaesthesia and was continued in a dose of 0.2-0.7 μg/kg/Hr until skin closure. All patients were induced with thiopentone, fentanyl and vecuronium. Haemodynamic variables were continuously recorded.
The need for thiopentone and isoflurane was decreased by 30% and 32%, respectively, in the dexmedetomidine group as compared to the control group. After tracheal intubation, maximal average increase was 8% in systolic and 11% in diastolic blood pressure in dexmedetomidine group, as compared to 40% and 25%, respectively, in the control group. Similarly, average increase in heart rate was 7% and 21% in the dexmedetomidine and control groups, respectively. Fentanyl requirement during the operation was 100±10 μg in the control group and 60±10 μg in the dexmedetomidine group.
Perioperative infusion of dexmedetomidine is effective in attenuating sympathoadrenal response to tracheal intubation. It has significant anaesthetic and opioid sparing effect.
右美托咪定是一种α-2肾上腺素能受体激动剂，因其具有抗交感神经、镇静、节省麻醉药物及稳定血流动力学特性且无明显呼吸抑制作用而越来越受到欢迎。
我们评估了右美托咪定减轻气管插管时交感肾上腺反应的效果，并分析了术中麻醉药物需求量的减少情况。随机选择60例计划进行超过3小时择期手术的患者。对照组接受异氟烷-阿片类麻醉，研究组接受异氟烷-阿片类-右美托咪定麻醉。在麻醉诱导前10分钟内给予1μg/kg剂量的右美托咪定静脉输注，并以0.2-0.7μg/kg/小时的剂量持续输注直至手术结束缝皮。所有患者均采用硫喷妥钠、芬太尼和维库溴铵诱导麻醉。持续记录血流动力学变量。
与对照组相比，右美托咪定组硫喷妥钠和异氟烷的需求量分别降低了30%和32%。气管插管后，右美托咪定组收缩压最大平均升高8%，舒张压最大平均升高11%，而对照组分别为40%和25%。同样，右美托咪定组和对照组心率平均升高分别为7%和21%。手术期间对照组芬太尼需求量为100±10μg，右美托咪定组为60±10μg。
围手术期输注右美托咪定可有效减轻气管插管时的交感肾上腺反应。它具有显著的麻醉和节省阿片类药物的作用。
