Agrawal Manish, Asthana Veena, Sharma Jagdish P
Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India.
Anesth Essays Res. 2014 Sep-Dec;8(3):302-6. doi: 10.4103/0259-1162.143117.
Midazolam and clonidine are preferred premedicants whose effects are not restricted to the preoperative period. In addition, these premedicants significantly modulate not only the intraoperative requirements of the anesthetic agents, but also the postoperative outcome. We aim to compare the efficacy of both the agents in view of premedication, induction characteristics, hemodynamic changes and postoperative complications utilizing bispectral index (BIS) using propofol anesthesia.
The type of this study was randomized control trial conducted on patients undergoing laparoscopic cholecystectomy under general anesthesia with endotracheal intubation. Study included 105 patients of either sex aged 20-60 years. The patients were randomly allocated into three groups: Intravenous midazolam (Group 1), clonidine (Group 2), and normal saline (Group 3) (control). The initial value of BIS and Ramsay Sedation Score, dose of propofol required for induction were noted in each group and monitored for pulse rate, electrocardiograph, noninvasive blood pressure, and BIS.
The requirement of propofol ranged from 40 to 150 mg. Mean requirement was maximum in Group 3 (109.43 ± 20.14 mg) and it was minimum in Group 1 (78.57 ± 22.15 mg). A significant reduction in consumption of propofol with the use of midazolam (P < 0.001) and clonidine (P < 0.001) was observed. Both premedicants partially attenuates laryngoscoy and intubation response along with reduction in the incidence of postoperative complications.
Both clonidine and midazolam contributed equally in lowering propofol consumption. Reduction in the induction dosage of propofol and hemodynamic variations were also observed to be similar with the use of midazolam or clonidine as premedicants. Both provide a beneficial effect in relation to recovery and less postoperative complications. However clonidine premedication was found to be more effective in preventing post operative shivering and can be recommended in routine practice.
咪达唑仑和可乐定是常用的术前用药，其作用不仅局限于术前阶段。此外，这些术前用药不仅能显著调节术中麻醉药物的需求量，还能影响术后结局。我们旨在通过使用丙泊酚麻醉并利用脑电双频指数（BIS），比较这两种药物在术前用药、诱导特征、血流动力学变化及术后并发症方面的疗效。
本研究类型为随机对照试验，针对接受全身麻醉下气管插管的腹腔镜胆囊切除术患者进行。研究纳入105例年龄在20至60岁之间的男女患者。患者被随机分为三组：静脉注射咪达唑仑组（第1组）、可乐定组（第2组）和生理盐水组（第3组，对照组）。记录每组患者的BIS初始值和 Ramsay镇静评分、诱导所需丙泊酚剂量，并监测脉搏率、心电图、无创血压和BIS。
丙泊酚需求量在40至150毫克之间。第3组的平均需求量最高（109.43±20.14毫克），第1组最低（78.57±22.15毫克）。观察到使用咪达唑仑（P<0.001）和可乐定（P<0.001）后丙泊酚消耗量显著减少。两种术前用药均能部分减轻喉镜检查和插管反应，并降低术后并发症的发生率。
可乐定和咪达唑仑在降低丙泊酚消耗量方面贡献相当。使用咪达唑仑或可乐定作为术前用药时，丙泊酚诱导剂量的减少和血流动力学变化也相似。两者在恢复和减少术后并发症方面均有有益作用。然而，发现可乐定术前用药在预防术后寒战方面更有效，可在常规实践中推荐使用。
