Polat R, Peker K, Baran I, Bumin Aydın G, Topçu Gülöksüz Ç, Dönmez A
Ministry of Health, Department of Anesthesiology Diskapi, Diskapi Yildirim Beyazit Research and Training Hospital, Ankara, Turkey.
Fen Faculty Statistics Department, Bartin University, Bartin, Turkey.
Anaesthesist. 2015 Oct;64(10):740-6. doi: 10.1007/s00101-015-0077-8. Epub 2015 Sep 2.
Postoperative emergency agitation (EA) is a common problem. Dexmedetomidine and remifentanil may be used to prevent this problem. Our primary aim was to compare dexmedetomidine, remifentanil, and placebo with respect to their effectiveness in preventing postoperative EA.
Ninety patients undergoing nasal surgery were randomized into three groups. The dexmedetomidine group (group D, n = 30) received dexmedetomidine infusion at a rate of 0.4 μg kg(-1 ) h(-1); the remifentanil group (group R, n = 30) received remifentanil infusion at a rate of 0.05 μg kg(-1) min(-1) from induction of anesthesia until extubation; and the control group (group S, n = 30) received a volume-matched normal saline infusion as a placebo. Propofol (1.5-2 mg kg(-1)) and fentanyl (1 μg kg(-1)) were used to initiate anesthesia, and desflurane was used to maintain anesthesia. The incidence of agitation, hemodynamic parameters, and recovery characteristics were evaluated during emergence.
The incidence of EA was significantly higher in group S (46.7%) compared with groups R and D (3.3 and 20%, respectively; p < 0.001). The lowest incidence of EA was detected in group R (p = 0.046). Residual sedation in the post-anesthesia care unit (PACU) was similar in all groups (p = 0.947). The incidence of nausea or vomiting was significantly lower in group D than in groups R and S (p = 0.043). Administration of analgesics in the PACU was higher in group R than in groups S and D (p = 0.015).
Anesthetic maintenance with either remifentanil or dexmedetomidine infusion until extubation provided a more smooth and hemodynamically stable emergence, without complications after nasal surgery. While remifentanil was superior to dexmedetomidine with regard to avoiding EA, dexmedetomidine was more effective than remifentanil regarding vomiting and pain.
术后紧急躁动（EA）是一个常见问题。右美托咪定和瑞芬太尼可用于预防该问题。我们的主要目的是比较右美托咪定、瑞芬太尼和安慰剂预防术后EA的有效性。
90例行鼻部手术的患者被随机分为三组。右美托咪定组（D组，n = 30）以0.4 μg·kg⁻¹·h⁻¹的速率输注右美托咪定；瑞芬太尼组（R组，n = 30）从麻醉诱导至拔管期间以0.05 μg·kg⁻¹·min⁻¹的速率输注瑞芬太尼；对照组（S组，n = 30）输注等体积的生理盐水作为安慰剂。使用丙泊酚（1.5 - 2 mg·kg⁻¹）和芬太尼（1 μg·kg⁻¹）诱导麻醉，使用地氟醚维持麻醉。在苏醒期间评估躁动发生率、血流动力学参数和恢复特征。
S组的EA发生率（46.7%）显著高于R组和D组（分别为3.3%和20%；p < 0.001）。R组的EA发生率最低（p = 0.046）。所有组在麻醉后恢复室（PACU）的残余镇静情况相似（p = 0.947）。D组的恶心或呕吐发生率显著低于R组和S组（p = 0.043）。R组在PACU使用镇痛药的情况高于S组和D组（p = 0.015）。
直至拔管前持续输注瑞芬太尼或右美托咪定维持麻醉，可使鼻部手术后的苏醒更平稳，血流动力学更稳定，且无并发症。虽然在避免EA方面瑞芬太尼优于右美托咪定，但在预防呕吐和疼痛方面右美托咪定比瑞芬太尼更有效。
