Manne Gourishankar Reddy, Upadhyay Mahendra R, Swadia Vn
Department of Anaesthesiology, Medical College, Vadodara, Gujarat, India.
Indian J Anaesth. 2014 Nov-Dec;58(6):726-31. doi: 10.4103/0019-5049.147164.
Dexmedetomidine is a α2 agonist with sedative, sympatholytic and analgesic properties and hence, it can be a very useful adjuvant in anaesthesia as stress response buster, sedative and analgesic. We aimed primarily to evaluate the effects of low dose dexmedetomidine infusion on haemodynamic response to critical incidences such as laryngoscopy, endotracheal intubation, creation of pneumoperitoneum and extubation in patients undergoing laparoscopic cholecystectomy. The secondary aims were to observe the effects on extubation time, sedation levels, post-operative analgesia requirements and occurrence of adverse effects.
Sixty patients of American Society of Anaesthesiologists(ASA) physical grades I and II undergoing laparoscopic cholecystectomy were randomly allocated into three groups of 20 patients each. Group NS patients received normal saline, Group Dex 0.2 and Group Dex 0.4 patients received dexmedetomidine infusion at 0.2 mcg/kg/h and 0.4 mcg/kg/h respectively, starting 15 min before induction and continued till end of surgery. Parameters noted were pulse rate, mean arterial pressure, oxygen saturation, post-operative sedation and analgesia requirements. SPSS 15.0 version software was used for statistical analysis. ANOVA test for continuous variables, post-hoc test for intergroup comparison, and Chi-square test for discrete values were applied.
In Group NS significant haemodynamic stress response was seen following laryngoscopy, tracheal intubation, creation of pneumoperitoneum and extubation. In dexmedetomidine groups, the haemodynamic response was significantly attenuated. The results, however, were statistically better in Dex 0.4 group compared with Dex 0.2 group. Post-operative 24 hour analgesic requirements were much less in dexmedetomidine groups. No significant side effects were noted.
Low dose dexmedetomidine infusion in the dose of 0.4 mcg/kg/h effectively attenuates haemodynamic stress response during laparoscopic surgery with reduction in post-operative analgesic requirements.
右美托咪定是一种具有镇静、抗交感神经和镇痛特性的α2激动剂，因此，它作为应激反应抑制剂、镇静剂和镇痛药，在麻醉中可能是一种非常有用的辅助药物。我们主要旨在评估低剂量右美托咪定输注对接受腹腔镜胆囊切除术患者在喉镜检查、气管插管、气腹形成和拔管等关键事件时血流动力学反应的影响。次要目的是观察对拔管时间、镇静水平、术后镇痛需求和不良反应发生情况的影响。
60例美国麻醉医师协会（ASA）身体状况分级为I级和II级的接受腹腔镜胆囊切除术的患者被随机分为三组，每组20例。生理盐水组患者输注生理盐水，右美托咪定0.2组和右美托咪定0.4组患者分别以0.2μg/kg/h和0.4μg/kg/h的速度输注右美托咪定，从诱导前15分钟开始，持续至手术结束。记录的参数包括脉搏率、平均动脉压、血氧饱和度、术后镇静和镇痛需求。使用SPSS 15.0版软件进行统计分析。对连续变量应用方差分析检验，对组间比较应用事后检验，对离散值应用卡方检验。
在生理盐水组，喉镜检查、气管插管、气腹形成和拔管后出现了显著的血流动力学应激反应。在右美托咪定组，血流动力学反应明显减弱。然而，右美托咪定0.4组的结果在统计学上比右美托咪定0.2组更好。右美托咪定组术后24小时的镇痛需求要少得多。未观察到显著的副作用。
以0.4μg/kg/h的剂量输注低剂量右美托咪定可有效减轻腹腔镜手术期间的血流动力学应激反应，并减少术后镇痛需求。
