Kim S H, Oh Y J, Park B W, Sim J, Choi Y S
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea -
Minerva Anestesiol. 2013 Nov;79(11):1248-58. Epub 2013 May 23.
Dexmedetomidine is a highly selective α2 agonist with analgesic, anxiolytic, and anti-inflammatory properties. We investigated the effect of a single dose of dexmedetomidine on patient-perceived quality of recovery and clinical recovery variables after modified radical mastectomy under general anesthesia in this randomized, double-blind, placebo-controlled study.
After Institutional Review Board approval, ninety two female patients were randomly allocated to receive intravenously either saline (Group C, N.=46) or 0.5 μg/kg of dexmedetomidine (Group D, N.=46) five min before the end of surgery. The quality of recovery was assessed using a 40-item quality-of-recovery scoring system (QoR-40) preoperatively and 24 h after surgery. Pain intensity, rescue analgesics, and postoperative nausea and vomiting (PONV) were assessed at postanesthesia care unit (PACU), 1-6 h, and 6-24 h after surgery.
Postoperative global QoR-40 scores were higher in Group D compared with Group C (181 [175-187] vs. 174 [154.5-181.5], P=0.004); postoperative QoR-40 scores were improved in the dimensions of emotional state, physical comfort, and psychological support. Total amount of tramadol during 24 h after surgery was significantly lower in Group D than in Group C (54 vs. 76 mg, P=0.006). The incidence of PONV was lower in Group D than in Group C in PACU (21% vs. 43%, P=0.026) and 6-24 h period after surgery (10% vs. 41%, P=0.012). Heart rate and mean blood pressure were significantly lower in Group D as compared with Group C at 5 min after administration of dexmedetomidine, 1 min after extubation, and 20 min after arrival in PACU.
The use of a single dose dexmedetomidine improved the quality of recovery and reduced analgesic requirements and the incidence of PONV in the early postoperative period after modified radical mastectomy.
右美托咪定是一种具有镇痛、抗焦虑和抗炎特性的高选择性α2激动剂。在这项随机、双盲、安慰剂对照研究中，我们调查了单剂量右美托咪定对全身麻醉下改良根治性乳房切除术后患者自我感觉的恢复质量和临床恢复变量的影响。
经机构审查委员会批准后，92例女性患者在手术结束前5分钟被随机分配静脉注射生理盐水（C组，n = 46）或0.5μg/kg右美托咪定（D组，n = 46）。术前及术后24小时使用40项恢复质量评分系统（QoR - 40）评估恢复质量。在麻醉后护理单元（PACU）、术后1 - 6小时和6 - 24小时评估疼痛强度、急救镇痛药使用情况及术后恶心呕吐（PONV）。
D组术后总体QoR - 40评分高于C组（181 [175 - 187] 对比174 [154.5 - 181.5]，P = 0.004）；术后QoR - 40评分在情绪状态、身体舒适度和心理支持维度有所改善。术后24小时内D组曲马多总量显著低于C组（54对比76mg，P = 0.006）。在PACU中，D组PONV发生率低于C组（21%对比43%，P = 0.026），且在术后6 - 24小时期间也是如此（10%对比41%，P = 0.012）。在给予右美托咪定后5分钟、拔管后1分钟及到达PACU后20分钟，D组心率和平均血压显著低于C组。
单剂量右美托咪定的使用改善了改良根治性乳房切除术后早期的恢复质量，减少了镇痛需求及PONV的发生率。
