Prasad S R, Simha Parimala Prasanna, Jagadeesh A M
Department of Cardiac Anaesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bannerghatta Road, Bangalore, Karnataka, India.
Indian J Anaesth. 2012 Nov;56(6):547-52. doi: 10.4103/0019-5049.104572.
To compare the efficacy of sedation and time taken for extubation using dexmedetomidine and fentanyl sedation in post-operative paediatric cardiac surgical patients.
A prospective randomized double-blind study involving 60 children undergoing open heart surgery was conducted. The patients were divided into two groups, each involving 30 patients. One group received fentanyl at 1 μg/kg/h (Group A) and the other received dexmedetomidine at 0.5 μg/kg/h (Group B) for post-operative sedation with intermittent rescue fentanyl 0.5 μg/kg bolus in either group as per requirement during suctioning. The efficacy of sedation was assessed using the Ramsay sedation score, paediatric intensive care unit sedation score and the tracheal suction score. The time taken for extubation from the stoppage of infusion was noted.
Haemodynamic parameters between the two groups were comparable. All sedation scores were comparable in the fentanyl and dexmedetomidine groups. Average time (in minutes) required for extubation was 131.0 (±51.06 SD) in the dexmedetomidine group compared with 373.0 (±121.4 SD) in the fentanyl group. The difference in mean time for extubation was statistically significant.
Dexmedetomidine facilitates adequate sedation for mechanical ventilation and also early extubation as compared with fentanyl.
比较右美托咪定和芬太尼用于小儿心脏术后患者镇静及拔管时间的效果。
进行一项前瞻性随机双盲研究，纳入60例接受心脏直视手术的儿童。患者分为两组，每组30例。一组以1μg/kg/h的速度输注芬太尼（A组），另一组以0.5μg/kg/h的速度输注右美托咪定（B组）用于术后镇静，根据需要在吸痰时两组均给予0.5μg/kg的冲击量芬太尼进行间断抢救。使用Ramsay镇静评分、儿科重症监护病房镇静评分和气管吸痰评分评估镇静效果。记录从停止输注到拔管所需的时间。
两组间血流动力学参数具有可比性。芬太尼组和右美托咪定组的所有镇静评分均具有可比性。右美托咪定组拔管所需的平均时间（分钟）为131.0（±51.06标准差），而芬太尼组为373.0（±121.4标准差）。拔管平均时间的差异具有统计学意义。
与芬太尼相比，右美托咪定有助于为机械通气提供充分镇静并实现早期拔管。
