Department of Anesthesiology, The Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Medical College of Fudan University, Shanghai 200031, China.
Br J Anaesth. 2014 May;112(5):892-7. doi: 10.1093/bja/aet490. Epub 2014 Feb 18.
To compare the safety and efficacy of dexmedetomidine/propofol (DP)-total i.v. anaesthesia (TIVA) vs remifentanil/propofol (RP)-TIVA, both with spontaneous breathing, during airway foreign body (FB) removal in children.
Seventy-seven children undergoing rigid bronchoscopy for FB removal were randomly allocated to receive either RP-TIVA and spontaneous ventilation (Group RP, n=38) or DP-TIVA and spontaneous ventilation (Group DP, n=39). Heart rate, arterial pressure, pulse oxygen saturation (Sp(O2)), respiratory rate, end-tidal CO2 (E'(CO2)), and induction time were recorded. Adverse events, the intervention for these events, and postoperative care duration were also assessed.
The mean induction times were comparable between the two groups (Group RP 12.2 min vs Group DP 13.1 min, P>0.05). At the end of the procedure, the mean (E'(CO2)) was higher in Group RP (Group RP 6.8 kPa vs Group DP 5.8 kPa, P<0.001), and respiratory rate was lower in Group RP (Group RP 20.4 vs Group DP 35.8, P<0.001). Additionally, the perioperative haemodynamic profile was more stable in Group DP than that in Group RP. The incidence rate of breath-holding and intervention were comparable between the two groups. In the post-anaesthesia care unit (PACU), no hypoxaemia was observed, and emergence time increased in Group DP (Group DP 65.1 min vs Group RP 23.8 min, P<0.0001). The incidence of cough in PACU was higher in Group RP (Group RP 55.3% vs Group DP 10.3%, P<0.0001).
Compared with RP-TIVA, DP-TIVA provided more stable respiratory and haemodynamic profiles, but required a longer recovery time. Clinical trial registration China Clinical Research Information Service, ChiCTR-TRC-13003018.
比较右美托咪定/丙泊酚（DP）-全静脉麻醉（TIVA）与瑞芬太尼/丙泊酚（RP）-TIVA 联合自主呼吸在儿童气道异物（FB）取出术中的安全性和有效性。
77 例因 FB 接受硬性支气管镜检查的儿童被随机分为接受 RP-TIVA 和自主通气（RP 组，n=38）或 DP-TIVA 和自主通气（DP 组，n=39）的患者。记录心率、动脉压、脉搏血氧饱和度（Sp（O2））、呼吸频率、呼气末 CO2（E'（CO2））和诱导时间。还评估了不良事件、这些事件的干预措施和术后护理时间。
两组的平均诱导时间相当（RP 组 12.2 分钟 vs DP 组 13.1 分钟，P>0.05）。在手术结束时，RP 组的 E'（CO2）平均值较高（RP 组 6.8 kPa vs DP 组 5.8 kPa，P<0.001），RP 组的呼吸频率较低（RP 组 20.4 次/分 vs DP 组 35.8 次/分，P<0.001）。此外，DP 组围手术期血流动力学状况比 RP 组更稳定。两组的呼吸暂停和干预发生率相当。在麻醉后恢复室（PACU）中，未观察到低氧血症，DP 组的苏醒时间延长（DP 组 65.1 分钟 vs RP 组 23.8 分钟，P<0.0001）。PACU 咳嗽发生率在 RP 组较高（RP 组 55.3% vs DP 组 10.3%，P<0.0001）。
与 RP-TIVA 相比，DP-TIVA 提供了更稳定的呼吸和血流动力学状况，但需要更长的恢复时间。临床试验注册 中国临床试验注册中心，ChiCTR-TRC-13003018。
