Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China.
Ann Pharmacother. 2013 Nov;47(11):1391-9. doi: 10.1177/1060028013504082. Epub 2013 Nov 5.
It has been reported that dexmedetomidine (DEX) can be used for conscious sedation in awake craniotomy, but few data exist to compare DEX versus propofol (PRO).
To compare the efficacy and safety of DEX versus PRO for conscious sedation in awake craniotomy.
Thirty patients of American Society of Anesthesiologists grade I-II scheduled for awake craniotomy, were randomized into 2 groups each containing 15 subjects. Group D received DEX and group P received PRO. Two minutes after tracheal intubation (T1), PRO (target plasma concentration) was titrated down to 1 to 4 µg/mL in group P. In group D, PRO was discontinued and DEX was administered 1.0 µg/kg followed by a maintenance dose of 0.2 to 0.7 µg/kg/h. The surgeon preset the anticipated awake point-in-time (T0) preoperatively. Ten minutes before T0 (T3), DEX was titrated down to 0.2 µg/kg/h in group D, PRO was discontinued and normal saline (placebo) 5 mL/h was infused in group P. Arousal time, quality of revival and adverse events during the awake period, degree of satisfaction from surgeons and patients were recorded.
Arousal time was significantly shorter in group D than in group P (P < .001). The quality of revival during the awake period in group D was similar to that of group P (P = .68). The degree of satisfaction of surgeons was significantly higher in group D than in group P (P < .001), but no difference was found between the 2 groups with respect to patient satisfaction (P = .80). There was no difference between the 2 groups in the incidence of adverse events during the awake period (P > .05).
Either DEX or PRO can be effectively and safely used for conscious sedation in awake craniotomy. Comparing the two, DEX produced a shorter arousal time and a higher degree of surgeon satisfaction.
已有报道称，右美托咪定（DEX）可用于清醒开颅术中的镇静，但比较 DEX 与丙泊酚（PRO）的相关数据较少。
比较 DEX 与 PRO 用于清醒开颅术中镇静的效果和安全性。
选择 30 例美国麻醉医师协会（ASA）分级Ⅰ-Ⅱ级的择期清醒开颅术患者，随机分为两组，每组 15 例。DEX 组（D 组）患者在气管插管后 2 分钟（T1）时给予 1.0 μg/kg 的负荷剂量，随后以 0.2-0.7 μg/（kg·h）的速度输注；PRO 组（P 组）患者在 T1 时给予 PRO，使其靶血浆浓度维持在 1-4 μg/mL。在 D 组，当 PRO 靶血浆浓度降至 1-4 μg/mL 时，停止输注 PRO，并给予 1.0 μg/kg 的负荷剂量，然后以 0.2-0.7 μg/（kg·h）的速度输注。手术医生在术前预设了预计清醒时间（T0）。在 T0 前 10 分钟（T3），D 组患者将 DEX 滴定至 0.2 μg/（kg·h），P 组停止输注 PRO，静脉输注生理盐水（安慰剂）5 mL/h。记录清醒期的苏醒时间、苏醒质量和不良反应、手术医生和患者的满意度。
D 组患者的苏醒时间明显短于 P 组（P<0.001）。D 组患者在清醒期间的苏醒质量与 P 组相似（P=0.68）。D 组患者的手术医生满意度明显高于 P 组（P<0.001），但两组患者对患者满意度的评价无差异（P=0.80）。两组患者在清醒期间的不良反应发生率无差异（P>0.05）。
DEX 或 PRO 均可有效、安全地用于清醒开颅术中的镇静。与 PRO 相比，DEX 可缩短苏醒时间，提高手术医生满意度。
