Department of Anesthesia and Intensive Care Medicine, Helsinki University Central Hospital, Haartmaninkatu 4, PL 340, 00029 HUS, Helsinki, Finland.
Surg Endosc. 2013 Jun;27(6):2163-8. doi: 10.1007/s00464-012-2734-1. Epub 2013 Jan 26.
There is a lack of studies about procedural sedation of alcoholics. Dexmedetomidine is recommended for procedural sedation and reported effective for alcohol withdrawal. We evaluated the suitability of dexmedetomidine for sedation of alcoholics during endoscopic retrograde cholangiopancreatography (ERCP).
Fifty patients with chronic alcoholism scheduled for elective ERCP were randomized 1:1 to receive dexmedetomidine (Dex group) (loading dose 1 μg kg(-1) over 10 min, followed by constant intravenous infusion 0.7 μg kg(-1) h(-1)) or saline placebo (P group). Patient-controlled sedation with propofol-alfentanil was used by patients as a rescue method. Sedation was considered as successful if no intervention of an anesthesiologist was needed. Consumption of sedatives was registered, and sedation levels and vital signs were monitored.
Dexmedetomidine alone was insufficient in all patients. The mean ± SD consumption of propofol was 159 ± 72 mg in the P group, and 116 ± 61 mg in the Dex group (p = 0.028). Sedation was successful in 19 of 25 (76 %) patients in the Dex group and in all patients in the P group (p = 0.022). The incidence of sedation adverse events did not differ between the groups. Dexmedetomidine was associated with delayed recovery.
Patient-controlled sedation with propofol and alfentanil but not dexmedetomidine can be recommended for sedation of alcoholics during ERCP.
目前缺乏关于酒精中毒患者镇静程序的研究。右美托咪定被推荐用于程序镇静，并报告对酒精戒断有效。我们评估了右美托咪定在酒精中毒患者内镜逆行胰胆管造影（ERCP）中镇静的适用性。
50 例慢性酒精中毒患者拟行择期 ERCP，随机 1:1 分为右美托咪定（Dex 组）（负荷剂量 1μg/kg，持续 10 分钟，然后静脉输注 0.7μg/kg/h）或生理盐水安慰剂（P 组）。患者采用丙泊酚-阿芬太尼自控镇静作为抢救方法。如果不需要麻醉师干预，则认为镇静成功。记录镇静药物的使用量，并监测镇静水平和生命体征。
Dex 组所有患者单独使用右美托咪定均不足。P 组丙泊酚的平均（±标准差）用量为 159±72mg，Dex 组为 116±61mg（p=0.028）。Dex 组 25 例患者中有 19 例（76%）镇静成功，而 P 组所有患者均成功（p=0.022）。两组镇静不良事件发生率无差异。右美托咪定与恢复延迟有关。
丙泊酚和阿芬太尼的患者自控镇静，但不是右美托咪定，可以推荐用于酒精中毒患者 ERCP 期间的镇静。
