Chen Jie, Zhou Jia-qian, Chen Zhi-feng, Huang Yan, Jiang Hong
Attending, Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Professor, Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Oral Maxillofac Surg. 2014 Feb;72(2):285.e1-7. doi: 10.1016/j.joms.2013.10.006. Epub 2013 Oct 25.
To compare the safety and efficacy of sedation induced by dexmedetomidine and propofol after oral and maxillofacial surgery.
In this trial, 66 patients 18 to 50 years old received oral and maxillofacial surgery and required postoperative nasal endotracheal intubation under overnight sedation with dexmedetomidine or propofol. The dexmedetomidine group (group D) received dexmedetomidine 1.0 μg/kg intravenously for 10 minutes after entering the recovery room. The dose was maintained by giving an intravenous injection of dexmedetomidine 0.4 μg/kg. The injection rate could be modulated from 0.2 to 0.7 μg/kg/hour in the intensive care unit (ICU). If the Ramsay score was lower than 2 and involuntary limb movement occurred, other sedatives were used. The propofol group (group P) was given propofol 0.1 mg/kg intravenously for 10 minutes after entering the recovery room and then maintained with intravenous injections of propofol 1 to 2 mg/kg/hour in the recovery room and ICU.
The oxygen desaturation of group P was higher than that of group D (at the first sedation time of 30 minutes), but the mean blood pressure of group P was significantly lower than that of group D at the 10-minute time point. The Ramsay score was higher in group D after the first 3 hours of sedation than in group P (P < .05).
Dexmedetomidine showed similar safety and efficacy as propofol and could be used for tube-retaining sedation after oral and maxillofacial surgery.
比较右美托咪定和丙泊酚用于口腔颌面外科手术后镇静的安全性和有效性。
在本试验中，66例年龄在18至50岁之间的患者接受了口腔颌面外科手术，术后需要在夜间镇静状态下进行鼻气管插管，使用右美托咪定或丙泊酚。右美托咪定组（D组）在进入恢复室后静脉注射右美托咪定1.0μg/kg，持续10分钟。剂量通过静脉注射右美托咪定0.4μg/kg维持。在重症监护病房（ICU），注射速率可在0.2至0.7μg/kg/小时之间调节。如果Ramsay评分低于2且出现肢体不自主运动，则使用其他镇静剂。丙泊酚组（P组）在进入恢复室后静脉注射丙泊酚0.1mg/kg，持续10分钟，然后在恢复室和ICU中以1至2mg/kg/小时的速率静脉注射丙泊酚维持。
P组的氧饱和度下降高于D组（在首次镇静30分钟时），但在10分钟时间点，P组的平均血压显著低于D组。镇静开始3小时后，D组的Ramsay评分高于P组（P<.05）。
右美托咪定与丙泊酚的安全性和有效性相似，可用于口腔颌面外科手术后的保留气管导管镇静。
