右美托咪定对接受骨科手术的老年患者麻醉平稳苏醒的影响。
Effects of dexmedetomidine on smooth emergence from anaesthesia in elderly patients undergoing orthopaedic surgery.
作者信息
Kim Dong Jun, Kim Sang Hun, So Keum Young, Jung Ki Tae
机构信息
Department of Anesthesiology and Pain Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, South Korea.
Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, South Korea.
出版信息
BMC Anesthesiol. 2015 Oct 7;15:139. doi: 10.1186/s12871-015-0127-4.
BACKGROUND
Intraoperative dexmedetomidine may decrease postoperative emergence agitation in elderly patients due to its sedative effect. In this study, we evaluated the effect of adjuvant dexmedetomidine on smooth emergence from anaesthesia after orthopaedic surgery in elderly patients.
METHODS
A total 115 patients (ASA I-II, aged over 65 years) were randomly allocated into four groups. Anaesthesia was maintained with either sevoflurane or total intravenous anaesthesia (TIVA) comprising propofol and remifentanil. Patients were also administered either dexmedetomidine (0.4 μg kg(-1) hr(-1); SD and TD) intraoperatively or normal saline (SN or TN) as a control. The bispectral index (BIS) score was maintained from 40-60 intraoperatively. All anaesthetics and dexmedetomidine were discontinued at surgical conclusion, and the recovery times (durations to a BIS = 60, 70, and 80; eye opening; and extubation) were measured. The mean arterial pressure, heart rate, Ricker's agitation-sedation scale (RSAS), visual analogue scale (VAS) for pain, and incidences of emergence agitation and postoperative nausea and vomiting (PONV) were measured in the recovery room.
RESULTS
Dexmedetomidine significantly decreased the RSAS score in the SD and TD groups, and a calm state postoperatively occurred more frequently in these groups than in the control groups. The heart rate and incidence of emergence agitation were lower in the dexmedetomidine groups. Recovery time was higher in the SD group than in the SN group, and no significant differences occurred between the TN and TD groups. The VAS score was lower in the SD group than in the SN group, and the PONV did not differ regardless of the use of dexmedetomidine.
CONCLUSIONS
Dexmedetomidine may be an effective intraoperative adjuvant for a reducing emergence agitation and smooth emergence from anaesthesia after orthopaedic surgery in elderly patients.
TRIAL REGISTRATION
Current Controlled Trials NCT01851005 .
背景
术中使用右美托咪定可能因其镇静作用而减少老年患者术后苏醒期躁动。在本研究中，我们评估了辅助使用右美托咪定对老年患者骨科手术后平稳苏醒的影响。
方法
总共115例患者（美国麻醉医师协会分级I-II级，年龄超过65岁）被随机分为四组。麻醉维持采用七氟醚或由丙泊酚和瑞芬太尼组成的全静脉麻醉（TIVA）。术中患者还接受右美托咪定（0.4μg·kg⁻¹·h⁻¹；SD组和TD组）或生理盐水（SN组或TN组）作为对照。术中双谱指数（BIS）值维持在40-60。手术结束时停用所有麻醉药和右美托咪定，并测量苏醒时间（BIS值分别达到60、70和80的持续时间、睁眼时间和拔管时间）。在恢复室测量平均动脉压、心率、里克镇静-躁动评分量表（RSAS）、疼痛视觉模拟量表（VAS）以及苏醒期躁动和术后恶心呕吐（PONV）的发生率。
结果
右美托咪定显著降低了SD组和TD组的RSAS评分，且这些组术后平静状态的发生率高于对照组。右美托咪定组的心率和苏醒期躁动发生率较低。SD组的苏醒时间高于SN组，TN组和TD组之间无显著差异。SD组的VAS评分低于SN组，无论是否使用右美托咪定，PONV发生率均无差异。
结论
右美托咪定可能是老年患者骨科手术后减少苏醒期躁动和实现平稳苏醒的有效术中辅助药物。
试验注册
当前受控试验NCT01851005 。
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