Wang Xiaoning, Jiang Tianle, Zhao Binjiang
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2014 Aug;28(15):1154-7.
To observe the effects of different maintain doses of Dexmedetomidine on plasma cortisol and glucose during anesthesia recovery period in patients undergoing uvulopalatopharyngoplasty under sevoflurane inhalation anesthesia.
In this prospective, randomized, double-blind study, 120 ASA I and II patients undergoing selective uvulopalatopharyngoplasty under general anesthesia were included. The patients were randomly allocated to three groups (n = 40): Dexmedetomidine low maintain dose group (D1), Dexmedetomidine high maintain dose group (group D2) and control group (group C). The Dexmedetomidine groups and control group were given Dexmedetomidine 1 microg/kg and normal saline in 20 ml within 15 min just before induction of anesthesia. Then Dexmedetomidine were maintained at 0.2 microg x kg(-1) x h(-1) and 0.7 microg x kg(-1) x h(-1) in group D1 and group D2 and were withdrawed 5 min before the end of operation, the same maintained speed of normal saline was given in group C. BIS value was maintained at 40-60 by adjusting the inhaled concentration of sevoflurane. Anesthetic was withdrawed 10 min before the end of operation. Thus, plasma cortisol concentration and blood glucose was needed to be detected just before anesthesia (T0), tracheal extubation (T1), 5 min after extubation (T2) and 15 min after extubation (T3). Duration of operation and anesthesia, consumption of sevoflurane, emergence time, extubation time, the occurrence of dysphoria, bucking and hypoxemia (SpO2 < 90%) during extubation were recorded.
Compared with group C, MAP and HR at T1, plasma cortisol concentration and blood glucose at T1 - T3 were all significantly lower in group D1 and group D2 (P < 0.05), and so were the consumption of sevoflurane and the occurrence of dysphoria (P < 0.05). The emergence time and extubation time were significantly prolonged in group D2 compared with group D1 and group C (P < 0.05). There was no significant difference in the occurrence of bucking and hypoxemia in three groups (P > 0.05).
In the patients undergoing UPPP under sevoflurane inhalation anesthesia, Dexmedetomidine infused at 0.2 microg x kg(-1) x h(-1) maintains a stable hemodynamics without respiratory depression, alleviates stress response during extubation and reduces both the consumption of sevoflurane and the occurrence of dysphoria without prolonging emergence time and extubation time.
观察七氟烷吸入麻醉下行悬雍垂腭咽成形术患者麻醉恢复期不同维持剂量右美托咪定对血浆皮质醇和血糖的影响。
在这项前瞻性、随机、双盲研究中，纳入120例接受全身麻醉下选择性悬雍垂腭咽成形术的美国麻醉医师协会（ASA）Ⅰ级和Ⅱ级患者。患者被随机分为三组（n = 40）：右美托咪定低维持剂量组（D1组）、右美托咪定高维持剂量组（D2组）和对照组（C组）。右美托咪定组和对照组在麻醉诱导前15分钟内给予右美托咪定1μg/kg和20ml生理盐水。然后D1组和D2组分别以0.2μg·kg⁻¹·h⁻¹和0.7μg·kg⁻¹·h⁻¹维持右美托咪定，手术结束前5分钟停药，C组给予相同维持速度的生理盐水。通过调整七氟烷吸入浓度将脑电双频指数（BIS）值维持在40 - 60。手术结束前10分钟停止麻醉。因此，需要在麻醉前（T0）、气管拔管时（T1）、拔管后5分钟（T2）和拔管后15分钟（T3）检测血浆皮质醇浓度和血糖。记录手术时间、麻醉时间、七氟烷用量、苏醒时间、拔管时间、拔管期间烦躁、呛咳及低氧血症（脉搏血氧饱和度（SpO2）< 90%）的发生情况。
与C组相比，D1组和D2组T1时的平均动脉压（MAP）和心率（HR）、T1 - T3时的血浆皮质醇浓度和血糖均显著降低（P < 0.05），七氟烷用量和烦躁发生率也显著降低（P < 0.05）。与D1组和C组相比，D2组的苏醒时间和拔管时间显著延长（P < 0.05）。三组呛咳和低氧血症的发生率差异无统计学意义（P > 0.05）。
在七氟烷吸入麻醉下行悬雍垂腭咽成形术的患者中，以0.2μg·kg⁻¹·h⁻¹输注右美托咪定可维持血流动力学稳定，无呼吸抑制，减轻拔管期间的应激反应，减少七氟烷用量和烦躁的发生，且不延长苏醒时间和拔管时间。
