Yağan Özgür, Karakahya Refika Hande, Taş Nilay, Küçük Ahmet
Department of Anaesthesiology and Reanimation, Ordu University Faculty of Medicine, Ordu, Turkey.
Department of Eye Diseases, Ordu University Faculty of Medicine, Ordu, Turkey.
Turk J Anaesthesiol Reanim. 2015 Apr;43(2):84-90. doi: 10.5152/TJAR.2014.45220. Epub 2015 Feb 5.
The aim of this study is to compare the sedative properties and haemodynamic and respiratory effects of dexmedetomidine and a ketamine-propofol combination (ketofol), which are expected to have minimal effects on spontaneous breathing.
Sixty patients were enrolled in this prospective randomised study. Patients were divided into 2 groups according to the administration of dexmedetomidine (Group D) and ketofol (Group K). Target sedation level was determined as a Ramsay Sedation Score of 3. In Group D, 0.5 mcg kg(-1) dexmedetomidine was administered via intravenous route in 10 minutes versus 0.125 mL kg(-1) of a solution containing 200 mg propofol and 100 mg ketamine in Group K. Haemodynamic and respiratory effects, postoperative awakening time, analgesic properties and satisfaction levels of the patients and surgeon were assessed.
There was a statistically significant decrease in mean arterial pressures following drug administration compared to initial measurements in both groups. However, there was a statistically significant decrease in heart rate only in Group D. There was no significant difference between the two groups regarding respiratory rate and protection of spontaneous respiration. Although the time for Aldrete score to be 9 was 16.1 minutes for Group K, it was 24.9 minutes for Group D, and this difference was statistically significant (p<0.01). There was no significant difference between the two groups regarding adverse effects, pain scores and satisfaction levels of the patients and surgeon.
Compared to dexmedetomidine, at similar sedation levels, sedation provided by ketofol enables satisfactory analgesia. Moreover, ketofol has a more rapid onset of action and a shorter recovery period from anaesthesia without causing significant haemodynamic or respiratory adverse effects.
本研究旨在比较右美托咪定与氯胺酮 - 丙泊酚组合（氯胺酚）的镇静特性、血流动力学及呼吸效应，预期二者对自主呼吸影响极小。
60例患者纳入本前瞻性随机研究。根据用药情况将患者分为两组，右美托咪定组（D组）和氯胺酚组（K组）。目标镇静水平确定为 Ramsay 镇静评分 3 分。D组在10分钟内静脉注射0.5 mcg/kg右美托咪定，K组静脉注射0.125 mL/kg含200 mg丙泊酚和100 mg氯胺酮的溶液。评估血流动力学和呼吸效应、术后苏醒时间、镇痛特性以及患者和外科医生的满意度。
与初始测量值相比，两组用药后平均动脉压均有统计学意义的下降。然而，仅D组心率有统计学意义的下降。两组在呼吸频率和自主呼吸保护方面无显著差异。K组 Aldrete 评分达 9 分的时间为 16.1 分钟，D组为 24.9 分钟，差异有统计学意义（p<0.01）。两组在不良反应、疼痛评分以及患者和外科医生的满意度方面无显著差异。
与右美托咪定相比，在相似镇静水平下，氯胺酚提供的镇静能实现满意镇痛。此外，氯胺酚起效更快，麻醉恢复期更短，且不会引起显著的血流动力学或呼吸不良反应。
