Department of Anesthesiology, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China.
Chin Med J (Engl). 2012 Mar;125(5):869-73.
Sedation for the coblation-assisted upper airway procedure has lacked easy modulation between appropriate pain control and airway protection. This study aimed to compare the effectiveness of dexmedetomidine versus target controlled propofol infusion in providing sedation during a coblation-assisted upper airway procedure.
In a prospective, randomized trial, 60 adult patients with obstructive sleep apnea syndrome due to undergoing a coblation-assisted upper airway procedure were enrolled and randomly allocated to receive dexmedetomidine, 1.0 µg/kg over 10 minutes and maintain dosage 0.7 µg×kg(-1)×h(-1) (n=30) or propofol target controlled infusion (n=30). Satisfaction with the analgesia and tolerance of the procedure by the patient, as assessed by a visual analogue scale, were evaluated as primary outcomes. Cardiopulmonary parameters and some side effects were monitored and recorded.
Both groups of 30 patients had comparable demographics and initial parameters. Patients in the propofol group reported more pain (P<0.05), tolerated the procedure less well (P<0.05), and were less satisfied with the different stages of procedure (P<0.05 or P<0.01). Changes in mean arterial pressure and heart rate were more dramatic in the propofol group (P<0.05). The dexmedetomidine group experienced fewer airway events and less respiratory depression than did the propofol group.
Dexmedetomidine in conjunction with local anesthesia offered better analgesia and conscious sedation for a coblation-assisted upper airway procedure as well as less airway obstruction, apnea and greater haemodynamic stability.
用于等离子辅助上气道手术的镇静剂在适当的疼痛控制和气道保护之间缺乏容易的调节。本研究旨在比较右美托咪定与靶控输注丙泊酚在等离子辅助上气道手术中提供镇静的效果。
前瞻性、随机试验中，纳入 60 例因行等离子辅助上气道手术而患有阻塞性睡眠呼吸暂停综合征的成年患者，并随机分为右美托咪定组（1.0μg/kg 静脉推注 10 分钟，然后维持 0.7μg×kg(-1)×h(-1)）（n=30）或丙泊酚靶控输注组（n=30）。通过视觉模拟评分评估患者对镇痛的满意度和对手术的耐受性，作为主要结局。监测并记录心肺参数和一些不良反应。
两组各 30 例患者的人口统计学和初始参数具有可比性。丙泊酚组患者报告的疼痛更严重（P<0.05），对手术的耐受性更差（P<0.05），对手术不同阶段的满意度更低（P<0.05 或 P<0.01）。丙泊酚组的平均动脉压和心率变化更显著（P<0.05）。与丙泊酚组相比，右美托咪定组发生气道事件和呼吸抑制的次数更少。
右美托咪定联合局部麻醉可为等离子辅助上气道手术提供更好的镇痛和意识镇静，且气道阻塞、呼吸暂停和血流动力学更稳定。
