Nasr Dalia Abdelhamid, Abdelhamid Hadeel Magdy
Department of Anesthesia and Intensive Care Medicine, Ain Shams University Hospitals, Abbassia, Cairo, Egypt.
Ann Card Anaesth. 2013 Apr-Jun;16(2):109-14. doi: 10.4103/0971-9784.109744.
We studied efficacy of caudal dexmedetomidine (DEX) on attenuation of perioperative stress response and postoperative pain in pediatric patients undergoing cardiac surgery.
Forty patients, (ASA II, III), 1-3-years old were randomly allocated into two groups; group BD received caudal bupivacaine 0.25%, 2.5 mg/kg and DEX 0.5 μg/kg and group BF received bupivacaine 2.5 mg/kg and fentanyl 1 μg/kg.
Serum cortisol and blood glucose levels increased in both groups but increases were significantly less in group BD. Poststernotomy cortisol level (ug/dl) was 55.3 ± 5.1 vs. 90.4 ± 6.5; after cardio-pulmonary bypass (CPB) 84.1 ± 6.2 vs. 153.1 ± 8.5; after operation 78.3 ± 8.1 vs. 150.2 ± 9.8. Poststernotomy blood glucose level (mg/dl) was 93.6 ± 7.2 vs. 125.6 ± 5.5; after CPB 115.3 ± 3.7 vs. 175.3 ± 10.4; and after operation 97.3 2 ± 3 vs. 162.2 ± 12. Heart rate and mean arterial pressure decreased significantly after caudal block in group BD relative to the baseline and compared with group BF ( P < 0.05). Group BD had lower pain scores at first hour 2 ± 0.7 vs. 3 ± 1.1 ( P = 0.04); second hour 1.9 ± 0.5 vs. 3.7 ± 0.8, ( P = 0.008); fourth hour 2.4 ± 0.8 vs. 4.3 ± 0.5 ( P = 0.03); and eighth hour 2.5 ± 0.5 vs. 4.2 ± 1.1 ( P = 0.03).
Caudal DEX attenuated stress response to surgical trauma and provided better postoperative analgesia.
我们研究了骶管注射右美托咪定（DEX）对接受心脏手术的儿科患者围手术期应激反应和术后疼痛的减轻效果。
40例年龄1 - 3岁、美国麻醉医师协会（ASA）分级为II、III级的患者被随机分为两组；BD组接受0.25%的骶管布比卡因2.5mg/kg和DEX 0.5μg/kg，BF组接受布比卡因2.5mg/kg和芬太尼1μg/kg。
两组患者的血清皮质醇和血糖水平均升高，但BD组的升高幅度明显较小。胸骨切开术后皮质醇水平（μg/dl）分别为55.3±5.1和90.4±6.5；体外循环（CPB）后分别为84.1±6.2和153.1±8.5；术后分别为78.3±8.1和150.2±9.8。胸骨切开术后血糖水平（mg/dl）分别为93.6±7.2和125.6±5.5；CPB后分别为115.3±3.7和175.3±10.4；术后分别为97.3±2.3和162.2±12。与基线相比，BD组骶管阻滞术后心率和平均动脉压显著降低，与BF组相比差异有统计学意义（P<0.05）。BD组在术后第1小时疼痛评分较低，分别为2±0.7和3±1.1（P = 0.04）；第2小时分别为1.9±0.5和3.7±0.8（P = 0.008）；第4小时分别为2.4±0.8和4.3±0.5（P = 0.03）；第8小时分别为2.5±0.5和4.2±1.1（P = 0.03）。
骶管注射DEX可减轻手术创伤引起的应激反应，并提供更好的术后镇痛效果。
