Eremenko A A, Chernova E V
Anesteziol Reanimatol. 2013 Sep-Oct(5):4-8.
to analyze the efficiency and safety of Dexmedetomidine infusion for a short-term controlled sedation and treatment of delirium in the early postoperative period in patients after cardiac surgery.
open, randomized, prospective study of 28 patients undergoing surgery on the heart or main blood vessels under general anaesthesia. In the early postoperative period all patients received an infusion of Dexmedetomidine (0.2-1.4 microg kg(-1) per hour) for sedation. The analgesia was carried out with Ketoprofen according to the protocol and Trimeperidine if VAS was > or = 3. Sedation and agitation levels were measured by Ramsay and RAAS scales, speed of awaking by Aldrete score. Duration of mechanical ventilation, length of stay in ICU, need for analgesics (VAS scale), type and frequency of side effects and vital signs (Harward standart) were recorded. Type of delirium, time of onset (days after surgery), dose and duration of psychomotor agitation were evaluated in patients with delirium (n = 9).
Dexmedetomidine infusion in the medium therapeutic doses resulted mild or moderate sedation remaining up to 12 hours after the infusion. More than 50% of patients had retrograde amnesia. The pain intensity did not exceed 1 point on VAS scale in 96% of patients. 23% of patients required an additional administration of Trimeperidine. The most common side effects were bradycardia (39%) and arterial hypotension (36%). The therapy with Dexmedetomidine provided the most optimal level of sedation compared to other combinations of drugs (haloperidol, midazolam, propofol) in patients with delirium according to sedation-agitation and awaking scales.
Dexmedetomidine provides dose-dependent sedation and retrograde amnesia without altering the verbal contact, does not cause respiratory depression. The drug has independent analgesic effect and proved to be effective in the treatment of delirium. The most frequent side effects of Dexmedetomidine are bradycardia and arterial hypotension.
分析右美托咪定输注用于心脏手术后患者术后早期短期控制性镇静及谵妄治疗的有效性和安全性。
对28例在全身麻醉下进行心脏或主要血管手术的患者进行开放、随机、前瞻性研究。术后早期，所有患者接受右美托咪定输注（每小时0.2 - 1.4微克/千克）以进行镇静。根据方案使用酮洛芬进行镇痛，若视觉模拟评分（VAS）≥3则使用哌替啶。通过Ramsay和RAAS量表测量镇静和躁动水平，通过Aldrete评分测量苏醒速度。记录机械通气时间、重症监护病房（ICU）住院时间、镇痛需求（VAS量表）、副作用类型和频率以及生命体征（哈佛标准）。对发生谵妄的患者（n = 9）评估谵妄类型、发病时间（术后天数）、精神运动性躁动的剂量和持续时间。
中等治疗剂量的右美托咪定输注导致轻至中度镇静，输注后可持续12小时。超过50%的患者有逆行性遗忘。96%的患者疼痛强度在VAS量表上不超过1分。23%的患者需要额外给予哌替啶。最常见的副作用是心动过缓（39%）和动脉低血压（36%）。根据镇静 - 躁动和苏醒量表，与其他药物组合（氟哌啶醇、咪达唑仑、丙泊酚）相比，右美托咪定治疗为谵妄患者提供了最理想的镇静水平。
右美托咪定提供剂量依赖性镇静和逆行性遗忘，且不改变言语交流，不引起呼吸抑制。该药物具有独立的镇痛作用，被证明对谵妄治疗有效。右美托咪定最常见的副作用是心动过缓和动脉低血压。
