Lu Chengxiang, Zhang Li-Ming, Zhang Yuehong, Ying Yanlu, Li Ling, Xu Lixin, Ruan Xiangcai
Department of Anesthesiology, First Municipal People's Hospital of Guangzhou, an Affiliate Hospital of Guangzhou Medical College, Guangzhou, China.
University of Pittsburgh Medical Centre, Pittsburgh, Pennsylvania, United States of America.
PLoS One. 2016 May 19;11(5):e0154192. doi: 10.1371/journal.pone.0154192. eCollection 2016.
Intranasal dexmedetomidine, a well-tolerated and convenient treatment option, has been shown to induce a favorable perioperative anxiolysis in children. We investigate intranasal dexmedetomidine as a sedative premedication for anesthesia recovery in an adult population.
A prospective randomized controlled trial; 81 adult patients scheduled for elective suspension laryngoscopy received intranasal dexmedetomidine (1 μg∙kg-1) or a placebo 45-60 min before anesthetic induction. Extubation time was used as the primary outcome measure. Secondary variables included the levels of sedation (Observer's Assessment of Alertness/Sedation scale, OAA/S) and anxiety (4-point anxiety score), anesthetic and analgesic requirements, hemodynamic fluctuations, and anesthesia recovery as well as side effects.
The levels of sedation and anxiety differed significantly between the two groups at anesthesia pre-induction (p < 0.001 and = 0.001, respectively). Repeated-measure general linear model determined no significant interaction effect between group and time on the targeted concentration of propofol (F = 1.635, p = 0.200), but a significant main effect of group existed (F = 6.880, p = 0.010). A moderate but significant decrease in the heart rate was recorded in the dexmedetomidine group at pre-induction. Episodes of tachycardia and hypertension after tracheal intubation and extubation were more frequent in the placebo group.
Intranasal dexmedetomidine as a sedative premedication induced a favorable perioperative anxiolysis without prolongation in anesthesia recovery; the hemodynamic effect was modest.
ClinicalTrials.gov NCT 02108171.
鼻内给予右美托咪定是一种耐受性良好且方便的治疗选择，已被证明可在儿童围手术期诱导良好的抗焦虑作用。我们研究鼻内给予右美托咪定作为成年人群麻醉恢复的镇静术前用药。
一项前瞻性随机对照试验；81例计划进行择期支撑喉镜检查的成年患者在麻醉诱导前45 - 60分钟接受鼻内右美托咪定（1μg∙kg-1）或安慰剂。拔管时间用作主要结局指标。次要变量包括镇静水平（观察者警觉/镇静评分量表，OAA/S）和焦虑水平（4分焦虑评分）、麻醉和镇痛需求、血流动力学波动、麻醉恢复情况以及副作用。
两组在麻醉诱导前的镇静和焦虑水平差异显著（分别为p < 0.001和 = 0.001）。重复测量的一般线性模型确定组与时间对丙泊酚目标浓度无显著交互作用（F = 1.635，p = 0.200），但存在显著的组主效应（F = 6.880，p = 0.010）。右美托咪定组在诱导前记录到心率有中度但显著的下降。安慰剂组气管插管和拔管后心动过速和高血压发作更频繁。
鼻内给予右美托咪定作为镇静术前用药可诱导良好的围手术期抗焦虑作用，且不延长麻醉恢复时间；血流动力学效应较小。
ClinicalTrials.gov NCT 02108171。
