Chaitanya G, Arivazhagan A, Sinha Sanjib, Madhusudan Reddy K R, Thennarasu K, Bharath R D, Rao M Bhaskara, Chandramouli B A, Satishchandra P
Department of Clinical Neuroscience, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India.
Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India.
J Neurosci Rural Pract. 2014 Nov;5(Suppl 1):S17-21. doi: 10.4103/0976-3147.145195.
Dexmedetomidine, a predominant alpha-2-adrenergic agonist has been used in anesthetic practice to provide good sedation. The drug is being recently used in neuroanesthesia during awake surgery for brain tumors and in functional neurosurgery.
This prospective study analyzed the hemodynamic effects of dexmedetomidine infusion during electrocorticography in patients undergoing surgery for mesial temporal sclerosis. Dexmedetomidine infusion was administered during intra-operative electrocorticography recording, 15 minutes after the end tidal MAC of N2O and isoflurane were decreased to zero. Anesthesia was maintained with O2 : air mixture = 50:50, vecuronium and fentanyl. Heart rate (HR), mean arterial pressure (MAP) and end tidal carbon dioxide (ETCO2) were recorded across at induction, 2 min prior to dexmedetomidine (PreDEX), 5 min during dexmedetomidine infusion (DEX; 1 μg/kg), 5 min after stopping dexmedetomidine and 10 minutes after stopping dexmedetomidine.
Forty patients with mesial temporal sclerosis (M: F = 27:13, mean age = 28.15 ± 10.9 years; duration of epilepsy = 12.0 ± 7.9 years) underwent anterior temporal lobe resection with amygdalohippocampectomy for drug-resistant epilepsy. Infusion of dexmedetomidine caused a transient fall in HR in 87.5% of patients and an increase in MAP in 62.5% of patients, which showed a tendency to revert back towards PreDEX values within 10 min after stopping the infusion. Sixty-five percent of the patients showed ≤25% reduction and 10% of them showed >25% reduction in HR. 47.5% of the patients showed ≤25% increase and 15% of them showed >25% increase in MAP. These changes were over a narrow range and within physiological limits.
The infusion of dexmedetomidine for a short period causes reduction of HR and increase in MAP in patients, however the variations are within acceptable range.
右美托咪定是一种主要的α-2肾上腺素能激动剂，已用于麻醉实践以提供良好的镇静效果。该药物最近被用于脑肿瘤清醒手术期间的神经麻醉以及功能神经外科手术中。
这项前瞻性研究分析了右美托咪定输注对内侧颞叶硬化症手术患者皮质电图监测期间血流动力学的影响。在术中皮质电图记录期间，当呼气末N2O和异氟烷的最低肺泡有效浓度（MAC）降至零时15分钟，开始输注右美托咪定。麻醉维持采用氧气：空气混合比为50:50、维库溴铵和芬太尼。记录诱导期、右美托咪定前2分钟（PreDEX）、右美托咪定输注期间5分钟（DEX；1μg/kg）、停止右美托咪定后5分钟以及停止右美托咪定后10分钟的心率（HR）、平均动脉压（MAP）和呼气末二氧化碳（ETCO2）。
40例内侧颞叶硬化症患者（男:女 = 27:13，平均年龄 = 28.15 ± 10.9岁；癫痫病程 = 12.0 ± 7.9年）接受了前颞叶切除术加杏仁核海马切除术治疗耐药性癫痫。输注右美托咪定导致87.5%的患者心率短暂下降，62.5%的患者平均动脉压升高，在停止输注后10分钟内有恢复至PreDEX值的趋势。65%的患者心率降低≤25%，其中10%的患者心率降低>25%。47.5%的患者平均动脉压升高≤25%，其中15%的患者平均动脉压升高>25%。这些变化范围较窄且在生理限度内。
短期输注右美托咪定可导致患者心率降低和平均动脉压升高，但其变化在可接受范围内。
