Rani P, Hemanth Kumar V R, Ravishankar M, Sivashanmugam T, Sripriya R, Trilogasundary M
Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, India.
Anesth Essays Res. 2016 Sep-Dec;10(3):597-601. doi: 10.4103/0259-1162.186605.
Fentanyl and dexmedetomidine have been tried to attenuate airway and circulatory reflexes during emergence and extubation individually but have not been compared with respect to the level of sedation to evolve a reliable technique for rapid and smooth extubation.
To compare the effects of fentanyl and dexmedetomidine in attenuating airway and circulatory reflexes during emergence and extubation of the endotracheal tube.
This double-blind, randomized, controlled study was done in patients undergoing surgery under general anesthesia belonging to the American Society of Anesthesiologists physical status 1 or 2.
All patients received a standardized anesthetic protocol. Patients were randomized to receive either fentanyl 1 μg/kg or dexmedetomidine 0.75 μg/kg. Fifteen minutes before expected last surgical suture, isoflurane was cutoff and equal amount of test solution was given when train-of-four ratio was 0.3. The degree of sedation, airway, and circulatory responses at the time of suction and extubation were analyzed.
Chi-square test for nonparametric data and -test for parametric data.
Heart rate (HR) was comparable in both the groups until endotracheal extubation. Later, there was rise in HR in fentanyl group. There was stastisticaly significant drop in blood pressure at 5 min after test drug administration in both the groups. Airway response for suctioning and extubation was better in dexmedetomidine group and it was associated with better sedation score than fentanyl group.
Single dose of 0.75 μg/kg dexmedetomidine given 15 min before extubation provides smooth extubation when compared to fentanyl.
芬太尼和右美托咪定已分别被尝试用于减轻苏醒和拔管期间的气道及循环反射，但尚未就镇静水平进行比较，以建立一种可靠的快速平稳拔管技术。
比较芬太尼和右美托咪定在气管插管患者苏醒和拔管期间减轻气道及循环反射的效果。
本双盲、随机、对照研究在接受全身麻醉、美国麻醉医师协会身体状况分级为1或2级的手术患者中进行。
所有患者均接受标准化麻醉方案。患者被随机分为两组，分别接受1 μg/kg芬太尼或0.75 μg/kg右美托咪定。预计最后一针手术缝线缝合前15分钟，停用异氟烷，当四个成串刺激比值为0.3时给予等量的试验溶液。分析吸痰和拔管时的镇静程度、气道及循环反应。
非参数数据采用卡方检验，参数数据采用t检验。
两组在气管拔管前心率（HR）相当。之后，芬太尼组心率上升。两组在给予试验药物后5分钟血压均有统计学意义的下降。右美托咪定组吸痰和拔管时的气道反应更好，且与比芬太尼组更好的镇静评分相关。
与芬太尼相比，拔管前15分钟给予单剂量0.75 μg/kg右美托咪定可实现平稳拔管。
