Kataria Amar Parkash, Attri Joginder Pal, Kashyap Ramita, Mahajan Leena
Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India.
Anesth Essays Res. 2016 Sep-Dec;10(3):446-450. doi: 10.4103/0259-1162.176407.
The advent of laparoscopic surgeries has proved to be beneficial for both patient and surgeon although increased morbidity may result from hemodynamic changes associated with laryngoscopy, intubation, and pneumoperitoneum (PNP).
The present study was prospective, randomized, double-blind conducted to evaluate the efficacy of dexmdetomidine and fentanyl in attenuation of pressor responses to laryngoscopy, intubation, and PNP in laparoscopic cholecystectomy (LC).
A total of 60 patients of 18-65 years, American Society of Anaesthesiologists Class I/II of either sex for elective LC, were included. The patients were divided into two groups of 30 patients each. Group I received dexmedetomidine and Group II Fentanyl loading 1 μg/kg over 15 min followed by maintenance 0.2 μg/kg/h throughout the PNP.
Heart rate (HR), systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure (MAP) were recorded preoperatively, 15 min after infusion of study drug, 1 min after induction, 1 min after intubation, throughout the PNP, end of surgery, and until 60 min in postoperative period. Sedation score, visual analog scale score along with modified Alderete score applied in postanesthesia care unit.
Control of HR and MAP in Group I was better than in Group II during laryngoscopy, intubation and PNP. There was also smooth extubation, less sedation and better control of pain in Group I than in Group II.
The present study demonstrates the benefits of dexmedetomidine over fentanyl in hemodynamic stability and analgesic quality in LC. Thus, it is establishing its utility over for attenuation of pressor response.
腹腔镜手术的出现已证明对患者和外科医生都有益，尽管与喉镜检查、插管和气腹（PNP）相关的血流动力学变化可能会导致发病率增加。
本研究为前瞻性、随机、双盲研究，旨在评估右美托咪定和芬太尼在减轻腹腔镜胆囊切除术（LC）中喉镜检查、插管和气腹时升压反应方面的疗效。
纳入60例年龄在18 - 65岁之间、美国麻醉医师协会分级为I/II级的择期LC患者，男女不限。患者被分为两组，每组30例。第一组接受右美托咪定，第二组在15分钟内静脉注射芬太尼负荷剂量1μg/kg，随后在整个气腹期间以0.2μg/kg/h维持。
术前、输注研究药物后15分钟、诱导后1分钟、插管后1分钟、整个气腹期间、手术结束时以及术后60分钟内记录心率（HR）、收缩压、舒张压和平均动脉压（MAP）。在麻醉后护理单元应用镇静评分、视觉模拟量表评分以及改良的阿尔德雷特评分。
在喉镜检查、插管和气腹期间，第一组的HR和MAP控制优于第二组。第一组的拔管过程也更平稳，镇静作用更小，疼痛控制更好。
本研究表明，在LC中，右美托咪定在血流动力学稳定性和镇痛质量方面优于芬太尼。因此，它在减轻升压反应方面确立了其效用。
