Department of Anesthesia and Surgical ICU, College of Medicine, University of Dammam, Al Khubar, Saudi Arabia
Int J Obstet Anesth. 2012 Jul;21(3):222-9. doi: 10.1016/j.ijoa.2012.04.006. Epub 2012 Jun 7.
Preoperative dexmedetomidine administration blunts haemodynamic and hormonal responses to tracheal intubation and reduces anaesthetic requirements. We hypothesized that dexmedetomidine would reduce the maternal haemodynamic and hormonal responses to elective caesarean delivery without harmful neonatal effects.
After ethical approval, 68 parturients scheduled for elective caesarean delivery under general anaesthesia were randomly allocated to receive either placebo, or 0.2, 0.4 or 0.6 μg/kg/h intravenous dexmedetomidine (n=17 per group) 20 min before induction. Anaesthesia was induced using a rapid-sequence technique with propofol and suxamethonium, and was maintained with 0.5-0.75 minimum alveolar concentration sevoflurane. Changes in maternal heart rate, mean blood pressure, minimum alveolar concentration sevoflurane, uterine tone, serum cortisol level, and Apgar scores, Neurologic Adaptive Capacity Scores and acid-base status were recorded.
After induction, patients receiving dexmedetomidine had smaller increases in heart rate (P<0.001) than those in the placebo group. Patients who received 0.4 and 0.6 μg/kg/h infusions of dexmedetomidine showed slower heart rates (-21.5% and -36%, respectively; P<0.001), lower mean blood pressures (-17% and -25%, respectively; P<0.001), sevoflurane minimum alveolar concentrations (-40% and -44.5%, respectively; P<0.001) and serum cortisol levels (-27% and -34.6%, respectively; P<0.001) and higher sedation scores for the first 15 min after extubation and greater uterine tone (P<0.002). Apgar scores, NACS and acid-base status were similar in the four groups.
Preoperative administration of dexmedetomidine 0.4 and 0.6 μg/kg/h is effective in attenuating the maternal haemodynamic and hormonal responses to caesarean delivery under sevoflurane anaesthesia without adverse neonatal effects.
术前给予右美托咪定可减轻气管插管时的血流动力学和激素反应，并减少麻醉药物的需求。我们假设右美托咪定可减轻择期剖宫产产妇的血流动力学和激素反应，而不产生有害的新生儿影响。
在获得伦理批准后，68 名择期全身麻醉下行剖宫产术的产妇被随机分为四组，分别接受安慰剂或 0.2、0.4 或 0.6μg/kg/h 的右美托咪定静脉输注（每组 17 例），在诱导前 20 分钟给予。麻醉诱导采用异丙酚和琥珀胆碱的快速序贯技术，维持 0.5-0.75 最低肺泡浓度七氟醚。记录产妇心率、平均血压、最低肺泡浓度七氟醚、子宫张力、血清皮质醇水平、新生儿 Apgar 评分、神经适应能力评分和酸碱状态的变化。
诱导后，接受右美托咪定的患者心率增加幅度小于安慰剂组（P<0.001）。接受 0.4 和 0.6μg/kg/h 右美托咪定输注的患者心率较慢（分别为-21.5%和-36%，P<0.001），平均血压较低（分别为-17%和-25%，P<0.001），七氟醚最低肺泡浓度（分别为-40%和-44.5%，P<0.001）和血清皮质醇水平（分别为-27%和-34.6%，P<0.001），拔管后 15 分钟内镇静评分较高，子宫张力较大（P<0.002）。四组新生儿 Apgar 评分、NACS 和酸碱状态相似。
术前给予 0.4 和 0.6μg/kg/h 的右美托咪定可有效减轻七氟醚麻醉下剖宫产产妇的血流动力学和激素反应，而不产生不良的新生儿影响。
