Aydogan Mustafa S, Korkmaz Mehmet F, Ozgül Ulkü, Erdogan Mehmet A, Yucel Aytac, Karaman Abdurrahman, Togal Turkan, Durmus Mahmut, Colak Cemil
Department of Anesthesiology and Reanimation, Faculty of Medicine, Inonu University, Malatya, Turkey.
Paediatr Anaesth. 2013 May;23(5):446-52. doi: 10.1111/pan.12128. Epub 2013 Feb 28.
The study aim was to compare the efficacy of dexmedetomidine vs midazolam for sedation during the early postoperative period in adolescents who underwent scoliosis surgery.
We performed a prospective, randomized trial in an intensive care unit (ICU) in a tertiary care center. In this study, 42 patients (American Society of Anesthesiology physical status I and II) who underwent scoliosis surgery were divided into two groups according to sedation protocols: group dexmedetomidine (DEX) (n = 22) and group midazolam (MDZ) (n = 20). Adolescents (12-18 years) requiring mechanical ventilation underwent a continuous infusion of either dexmedetomidine (group DEX; starting dose, 0.4 μg·kg(-1) ·h(-1)) or midazolam (group MDZ; starting dose, 0.1 mg·kg(-1) ·h(-1)) with intermittent fentanyl, as needed. The efficacy of sedation was assessed using the Richmond Agitation Sedation Scale (RASS). Quality of pain relief was measured using the Numeric Visual Analog Scale (NVAS). Delirium was determined in patients in the RASS range of -2 to +1 using the Confusion Assessment Method for the ICU (CAM-ICU). Fentanyl consumption, incidence of delirium, NVAS scores, and hemodynamics were recorded postoperatively at 2, 4, 6, and 24 h in the ICU.
The NVAS pain scores and fentanyl consumption at all the evaluation time points were significantly higher in group MDZ than those in group DEX (P < 0.05). Further, total fentanyl consumption in group MDZ was significantly higher than that in group DEX (P < 0.05). Delirium was significantly higher in the group MDZ than that in group DEX (31.3% vs 12.5%) when analyzed as the endpoint of CAM-ICU (P < 0.05). The heart rate was significantly lower in group DEX compared with that in group MDZ at all the evaluation time points (P < 0.05).
Dexmedetomidine was associated with the decreased postoperative fentanyl consumption, NVAS scores, and a decreased incidence of delirium. These findings may be beneficial for managing sedation protocols in adolescents who have undergone scoliosis surgery.
本研究旨在比较右美托咪定与咪达唑仑在青少年脊柱侧弯手术后早期镇静的疗效。
我们在一家三级护理中心的重症监护病房（ICU）进行了一项前瞻性随机试验。在本研究中，42例接受脊柱侧弯手术的患者（美国麻醉医师协会身体状况I级和II级）根据镇静方案分为两组：右美托咪定组（DEX组）（n = 22）和咪达唑仑组（MDZ组）（n = 20）。需要机械通气的青少年（12 - 18岁）持续输注右美托咪定（DEX组；起始剂量，0.4μg·kg⁻¹·h⁻¹）或咪达唑仑（MDZ组；起始剂量，0.1mg·kg⁻¹·h⁻¹），并根据需要间断使用芬太尼。使用里士满躁动镇静量表（RASS）评估镇静效果。使用数字视觉模拟量表（NVAS）测量疼痛缓解质量。使用重症监护病房意识模糊评估方法（CAM - ICU）确定RASS范围在 - 2至 +1的患者是否发生谵妄。在ICU术后2、4、6和24小时记录芬太尼消耗量、谵妄发生率、NVAS评分和血流动力学指标。
MDZ组在所有评估时间点的NVAS疼痛评分和芬太尼消耗量均显著高于DEX组（P < 0.05）。此外，MDZ组的总芬太尼消耗量显著高于DEX组（P < 0.05）。以CAM - ICU为终点分析时，MDZ组的谵妄发生率显著高于DEX组（31.3%对12.5%）（P < 0.05）。DEX组在所有评估时间点的心率均显著低于MDZ组（P < 0.05）。
右美托咪定与术后芬太尼消耗量减少、NVAS评分降低以及谵妄发生率降低相关。这些发现可能有助于管理接受脊柱侧弯手术的青少年的镇静方案。
